Provider Demographics
NPI:1942050182
Name:KRUZEL, KIMBERLY LYNNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:KRUZEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BALDWIN GREEN CMN STE 204
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1868
Mailing Address - Country:US
Mailing Address - Phone:781-938-8558
Mailing Address - Fax:
Practice Address - Street 1:3 BALDWIN GREEN CMN STE 204
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1868
Practice Address - Country:US
Practice Address - Phone:781-938-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL12077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist