Provider Demographics
NPI:1972516052
Name:O'LEARY, KIMBERLY L (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:FOTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03220
Mailing Address - Country:US
Mailing Address - Phone:603-524-3397
Mailing Address - Fax:603-524-9364
Practice Address - Street 1:2 PILLSBURY STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-524-3397
Practice Address - Fax:903-524-9364
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081063Medicaid
NH08Y005035NH02OtherANTHEM
NH7556712OtherAETNA
NH30393167Medicaid
NH3434134OtherCIGNA
NH30393167Medicaid
NH3081063Medicaid