Healthcare Provider Details

I. General information

NPI: 1467708628
Provider Name (Legal Business Name): MRS. KIMBERLY MCGRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY SULLIVAN OTR/L

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 11/12/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KEEWAYDIN DR
SALEM NH
03079-2839
US

IV. Provider business mailing address

44 NORSEMAN DR
SOUTH DENNIS MA
02660-3210
US

V. Phone/Fax

Practice location:
  • Phone: 800-995-2673
  • Fax: 866-420-1055
Mailing address:
  • Phone: 508-360-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9334
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: