MEDICARE: KIMBERLY FAGIOLO

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	225X00000X	Occupational Therapist	447	NE

General Provider Information

NPI Number	:	1972764421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FAGIOLO

Provider Business Mailing Address
First Line	:	2329 W 10TH ST
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-3537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 N WILLSON ST
Second Line	:
City	:	BLUE HILL
State	:	NE
Zip	:	68930-3507
Country	:	US
Telephone Number	:	402-756-2080
Fax Number	:

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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Directions to “ KIMBERLY FAGIOLO ” Practice Location

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