Provider Demographics
NPI:1649027467
Name:SANTANIELLO, KIMBERLY MARIE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:SANTANIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DEWING SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK VALLEY
Mailing Address - State:CT
Mailing Address - Zip Code:06282-1902
Mailing Address - Country:US
Mailing Address - Phone:719-433-8442
Mailing Address - Fax:
Practice Address - Street 1:239 MILL ST STE B
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3191
Practice Address - Country:US
Practice Address - Phone:508-752-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist