MEDICARE: MRS. JULIE MARIE KWILINSKI BS, CMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1366622391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE MARIE KWILINSKI BS, CMHP

Provider Business Mailing Address
First Line	:	200 AVENUE F NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4131
Country	:	US
Telephone Number	:	863-385-5179
Fax Number	:	863-385-0746

Provider Business Practice Location Address
First Line	:	5825 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-1216
Country	:	US
Telephone Number	:	863-385-5179
Fax Number	:	863-385-0746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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