Healthcare Provider Details

I. General information

NPI: 1376458224
Provider Name (Legal Business Name): KIMBERLY RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 JACKSON ST
NIAGARA WI
54151-1233
US

IV. Provider business mailing address

656 RICE RD
NIAGARA WI
54151-9233
US

V. Phone/Fax

Practice location:
  • Phone: 906-221-0392
  • Fax:
Mailing address:
  • Phone: 906-221-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: