Provider Demographics
NPI:1992514202
Name:BOSTON, KYMBERLEE ANN (OTD OTR/L)
Entity type:Individual
Prefix:
First Name:KYMBERLEE
Middle Name:ANN
Last Name:BOSTON
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W GRIFFIN DR STE A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2578
Mailing Address - Country:US
Mailing Address - Phone:406-298-3851
Mailing Address - Fax:406-578-1443
Practice Address - Street 1:612 W GRIFFIN DR STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2578
Practice Address - Country:US
Practice Address - Phone:406-298-3851
Practice Address - Fax:406-578-1443
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-10501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist