Provider Demographics
NPI:1053520510
Name:KIMBLER, AMY LOU (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOU
Last Name:KIMBLER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7890 PALMGREN AVE NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4548
Mailing Address - Country:US
Mailing Address - Phone:763-565-0356
Mailing Address - Fax:
Practice Address - Street 1:7890 PALMGREN AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-4548
Practice Address - Country:US
Practice Address - Phone:763-565-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist