Provider Demographics
NPI:1851542492
Name:LORD, KIMBERLY JEAN (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:LORD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 ROUTE 7 S UNIT 102
Mailing Address - Street 2:PO BOX 526
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3807
Mailing Address - Country:US
Mailing Address - Phone:802-893-1413
Mailing Address - Fax:802-893-2253
Practice Address - Street 1:414 ROUTE 7 S UNIT 102
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3807
Practice Address - Country:US
Practice Address - Phone:802-893-1413
Practice Address - Fax:802-893-2253
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00001082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer