Provider Demographics
NPI:1104582972
Name:GREENBERG, KIMBERLY KATE (OTD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KATE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SAINT PAUL ST APT 101
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6598
Mailing Address - Country:US
Mailing Address - Phone:847-507-5860
Mailing Address - Fax:
Practice Address - Street 1:200 IVY ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3907
Practice Address - Country:US
Practice Address - Phone:617-732-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056014463225X00000X
MA13759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist