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General NPI Number Information
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NPI Number | 1730480591
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Entity Type | Organization
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Legal Business Name | BRAIN FUNCTION CLINIC
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 27499 RIVERVIEW CENTER BLVD
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4313
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Country | US
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Telephone | 239-403-8883
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Fax | 239-403-8881
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Provider Business Mailing Address
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Address Line | 27499 RIVERVIEW CENTER BLVD
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4313
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Country | US
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Telephone | 239-403-8883
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Fax | 239-403-8881
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Authorized Official
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Title or Position | OWNER SOLE PRACTITIONER
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Name | DR. HOWARD MICHAEL KALTER
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Credential | PH.D.
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Telephone | 239-403-8883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY5251
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License Number State | FL
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