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1770603862
KIMBERLY DIANE BOULLARD
PROVIDENCE, RI
NPI
1770603862
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Former Name
KIMBERLY DIANE BACKUNAS
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: RI OT 01140)
Enumeration Date
2007-03-30
Last Update Date
2007-07-08
Business Address
Ms. KIMBERLY DIANE BOULLARD OTR
1000 EDDY STREET
PROVIDENCE, RI 02905
Phone number: 401-533-9100
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Mailing Address
Ms. KIMBERLY DIANE BOULLARD OTR
9-1 TUCK FARM RD
AUBURN, MA 01501-2455
Phone number: 508-832-8041
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