1982895876 NPI number — DR. KIMBERLY SUE PEER ED.D., ATC, LAT

Table of content: DR. KIMBERLY SUE PEER ED.D., ATC, LAT (NPI 1982895876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982895876 NPI number — DR. KIMBERLY SUE PEER ED.D., ATC, LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEER
Provider First Name:
KIMBERLY
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D., ATC, LAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982895876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5190 - ROOM 161D MACC ANNEX
Provider Second Line Business Mailing Address:
KENT STATE UNIVERSITY
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44242-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-672-0231
Provider Business Mailing Address Fax Number:
330-672-4106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KENT STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
161D MACC ANNEX
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44242-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-672-0231
Provider Business Practice Location Address Fax Number:
330-672-4106
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT-122 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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