Provider Demographics
NPI:1538048269
Name:SANTOS, KIMBERLY (OTD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SANTOS
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 BROADWAY APT 117
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2451
Mailing Address - Country:US
Mailing Address - Phone:781-645-8873
Mailing Address - Fax:
Practice Address - Street 1:2 BROADWAY APT 117
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2451
Practice Address - Country:US
Practice Address - Phone:781-645-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL36321225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics