Provider Demographics
NPI:1710457932
Name:LEIBEL, KIMBERLY (ATC, NRP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LEIBEL
Suffix:
Gender:F
Credentials:ATC, NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-0174
Mailing Address - Country:US
Mailing Address - Phone:605-481-5000
Mailing Address - Fax:
Practice Address - Street 1:1302 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-5704
Practice Address - Country:US
Practice Address - Phone:605-481-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1558146L00000X
SD03612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic