Provider Demographics
NPI:1063471100
Name:ALERCIO, KIMBERLY A (OT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:ALERCIO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:VT
Mailing Address - Zip Code:05824-9418
Mailing Address - Country:US
Mailing Address - Phone:609-433-3438
Mailing Address - Fax:
Practice Address - Street 1:49 PERKINS ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1934
Practice Address - Country:US
Practice Address - Phone:609-433-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTR01031225X00000X
VT072-0000588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
063476VDEMedicare ID - Type Unspecified