MEDICARE: KIMBERLY SUE WOODS

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
1	225700000X	Massage Therapist		IL

General Provider Information

NPI Number	:	1164633210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SUE WOODS

Provider Business Mailing Address
First Line	:	2490 S 70TH ST
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-8702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 LEWIS PARK DR
Second Line	:
City	:	MT ZION
State	:	IL
Zip	:	62549-1202
Country	:	US
Telephone Number	:	217-864-2178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY SUE WOODS ” Practice Location

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