MEDICARE: DR. ISABELLE B. KING B.S, M.ED, PH.D.

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	103T00000X	Psychologist	MA 1686	MA
2	103TC0700X	Clinical Psychologist	FACCT CPY0329010311	FL

General Provider Information

NPI Number	:	1114211802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISABELLE B. KING B.S, M.ED, PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 730427
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32173-0427
Country	:	US
Telephone Number	:	386-871-7727
Fax Number	:	386-673-8329

Provider Business Practice Location Address
First Line	:	1452 N US HIGHWAY 1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6638
Country	:	US
Telephone Number	:	386-871-7727
Fax Number	:	386-673-8329

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	03/22/2013

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