Provider Demographics
NPI:1912119512
Name:TAMBELLINI, KIMBERLY RIVERS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RIVERS
Last Name:TAMBELLINI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 NE 7TH ST
Mailing Address - Street 2:#A
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-951-4930
Mailing Address - Fax:
Practice Address - Street 1:1309 NE 7TH ST
Practice Address - Street 2:#A
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1362
Practice Address - Country:US
Practice Address - Phone:541-951-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12754225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist