Individual
KIM M WATERBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTRL, CHT
Contact information
Practice address
8100 NORTHLAND DR, BLOOMINGTON, MN 55431-4800
(952) 831-8742
Mailing address
2532 EAGLE VALLEY DR, WOODBURY, MN 55129-4206
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102434
MN
Other
Enumeration date
06/27/2007
Last updated
07/08/2007
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