Most Relevant Information
Provider Data
| NPI Number: | 1003447822 |
| Provider Name: | KIM MAILLOUX |
| Entity Type: | Individual |
| Taxonomy Code: | 222Q00000X |
| Specialty: | Developmental Therapist |
| License Number: | 505250 |
Most Important Dates
| Enumeration Date: | 01/30/2020 |
| Last Updated: | 01/30/2020 |
Provider Practice Location
239 MILL ST
WORCESTER
MA
016023191
Practice Location Phone/Fax
| Phone: | 5087528466 |
| Fax: |
Provider Mailing Location
239 MILL ST
WORCESTER
MA
016023191
Provider Mailing Phone/Fax
| Phone: | 5087528466 |
| Fax: |