Individual
MS. KIMBERLY DIANE BOULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1000 EDDY STREET, PROVIDENCE, RI 02905
(401) 533-9100
Mailing address
9-1 TUCK FARM RD, AUBURN, MA 01501-2455
(508) 832-8041
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 01140
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2058
NHPRC
RI
01
—
640014
UNITED
RI
01
—
99947
BCROSS
RI
Enumeration date
03/30/2007
Last updated
07/08/2007
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