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NPI Code Detail

MEDICARE: KIMBERLY DANIELLE PERRY LMT, OTA, BT

MEDICARE: KIMBERLY DANIELLE PERRY LMT, OTA, BT
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
1225700000XMassage Therapist0019010960VA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1063055333
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY DANIELLE PERRY LMT, OTA, BT
Provider Business Mailing Address
First Line : 618 VILLAGE DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-4250
Country : US
Telephone Number : 757-221-1315
Fax Number :
Provider Business Practice Location Address
First Line : 618 VILLAGE DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-4250
Country : US
Telephone Number : 757-221-1315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2019
Last Update Date : 09/12/2024

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Directions to “ KIMBERLY DANIELLE PERRY LMT, OTA, BT” Practice Location

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