Provider Demographics
NPI:1740589845
Name:SCHOESSOW, KIMBERLY A (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:SCHOESSOW
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 APPLETON ST
Mailing Address - Street 2:APT 1
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1606
Mailing Address - Country:US
Mailing Address - Phone:650-867-4044
Mailing Address - Fax:
Practice Address - Street 1:799 W BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-3071
Practice Address - Country:US
Practice Address - Phone:508-854-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9759225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision