MEDICARE: KRISTEN NICHOLE KIMBALL MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1639666084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NICHOLE KIMBALL MT-BC

Provider Business Mailing Address
First Line	:	3950 N THOMAS RD
Second Line	:
City	:	FREELAND
State	:	MI
Zip	:	48623-8864
Country	:	US
Telephone Number	:	989-397-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 YORKSHIRE DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9244
Country	:	US
Telephone Number	:	989-992-3070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	04/20/2018

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Directions to “ KRISTEN NICHOLE KIMBALL MT-BC” Practice Location

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