Provider Demographics
NPI:1861847303
Name:MUNSEY, KIM (ATC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MUNSEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:LEVERONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:85 LOWDER ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4299
Mailing Address - Country:US
Mailing Address - Phone:781-493-6413
Mailing Address - Fax:
Practice Address - Street 1:85 LOWDER ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4299
Practice Address - Country:US
Practice Address - Phone:781-493-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer