Provider Demographics
NPI:1760466965
Name:QUAMME, KIMBERLY (OT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:QUAMME
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:DELANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:19 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2627
Mailing Address - Country:US
Mailing Address - Phone:978-988-7801
Mailing Address - Fax:
Practice Address - Street 1:70 BUTLER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3925
Practice Address - Country:US
Practice Address - Phone:602-893-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3610225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705314Medicaid
MA0705314Medicaid