=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811219934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINDER INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2010
-----------------------------------------------------
Last Update Date | 02/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2479 ALOMA AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-898-7798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2479 ALOMA AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-898-7798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. PATRICIA KILLGORE TEAL
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 407-898-7798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | SW6468
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | SW6468
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------