=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700027935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY A RIENDEAU LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2009
-----------------------------------------------------
Last Update Date | 03/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 OLD NASHUA RD UNIT 1
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03031-2844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-566-1829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 COLBURN RD
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03055-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-566-1829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 1702M
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------