Provider Demographics
NPI:1730227711
Name:COYLE, KIMBERLY (MT, AMTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:MT, AMTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOX WAY
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-2011
Mailing Address - Country:US
Mailing Address - Phone:508-725-5337
Mailing Address - Fax:
Practice Address - Street 1:645 STATE ROAD
Practice Address - Street 2:IN NAILZ ETC
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-2551
Practice Address - Country:US
Practice Address - Phone:508-725-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA438743-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist