Provider Demographics
NPI:1548842982
Name:GIAMBROCCO, KIMBERLY CARTER (MSOT/L)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CARTER
Last Name:GIAMBROCCO
Suffix:
Gender:F
Credentials:MSOT/L
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:CARTER
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT/L
Mailing Address - Street 1:34 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4402
Mailing Address - Country:US
Mailing Address - Phone:978-230-1341
Mailing Address - Fax:
Practice Address - Street 1:34 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4402
Practice Address - Country:US
Practice Address - Phone:978-230-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist