Healthcare Provider Details

I. General information

NPI: 1447030747
Provider Name (Legal Business Name): KIMBERLY LYNN REILLY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ALLENS AVE
PROVIDENCE RI
02905-5443
US

IV. Provider business mailing address

2548 HORTON ST
NORTH DIGHTON MA
02764-1900
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-6800
  • Fax:
Mailing address:
  • Phone: 508-558-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13876
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: