Healthcare Provider Details

I. General information

NPI: 1710317243
Provider Name (Legal Business Name): ALTERMEASE S. KIMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 N ORANGE BLOSSOM TRL STE 110
ORLANDO FL
32810-1016
US

IV. Provider business mailing address

5104 N ORANGE BLOSSOM TRL STE 110
ORLANDO FL
32810-1016
US

V. Phone/Fax

Practice location:
  • Phone: 407-879-3951
  • Fax: 407-286-2980
Mailing address:
  • Phone: 407-879-3951
  • Fax: 407-286-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberF113657588001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: