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General NPI Number Information
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NPI Number | 1144987447
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Entity Type | Individual
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Provider Name | KIM FOREHAND-VAN DER LINDE PHD, LMT
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Gender | Female
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Dates
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Enumeration Date | 11/21/2021
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Last Update Date | 11/21/2021
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Provider Practice Location Address
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Address Line | 1342 TIMBERLANE RD STE 102A
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City | TALLAHASSEE
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State | FL
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Zip | 32312-1775
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Country | US
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Telephone | 850-363-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 477 SMALL POND RD
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City | HAVANA
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State | FL
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Zip | 32333-4896
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Country | US
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Telephone | 850-363-8897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA92689
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License Number State | FL
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