MEDICARE: MISS KIMBERLY O'CONNOR

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	235Z00000X	Speech-Language Pathologist	SA8066	FL

General Provider Information

NPI Number	:	1437188828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY O'CONNOR

Provider Business Mailing Address
First Line	:	3430 HWY 77
Second Line	:	SUITE B
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-5024
Country	:	US
Telephone Number	:	850-215-1600
Fax Number	:	850-215-1602

Provider Business Practice Location Address
First Line	:	3430 HWY 77
Second Line	:	SUITE B
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-5024
Country	:	US
Telephone Number	:	850-215-1600
Fax Number	:	850-215-1602

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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Directions to “ MISS KIMBERLY O'CONNOR ” Practice Location

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