Provider Demographics
NPI:1760163901
Name:QUITTSCHREIBER, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:QUITTSCHREIBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 IVY AVE SE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MN
Mailing Address - Zip Code:56368-4509
Mailing Address - Country:US
Mailing Address - Phone:320-321-0166
Mailing Address - Fax:320-321-0167
Practice Address - Street 1:307 IVY AVE SE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MN
Practice Address - Zip Code:56368-4509
Practice Address - Country:US
Practice Address - Phone:320-321-0166
Practice Address - Fax:320-321-0167
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMTMN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist