Provider Demographics
NPI:1730981424
Name:DECLAIRE, KIMBERLY A
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:DECLAIRE
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 1:753 MALETA LN STE 101F
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7605
Mailing Address - Country:US
Mailing Address - Phone:303-351-2248
Mailing Address - Fax:
Practice Address - Street 1:753 MALETA LN STE 101F
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7605
Practice Address - Country:US
Practice Address - Phone:303-351-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0025885225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist