MEDICARE: KIM MARIE DODSON BA

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	104100000X	Social Worker
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1316064702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM MARIE DODSON BA

Provider Business Mailing Address
First Line	:	1501 SE 13TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-6713
Country	:	US
Telephone Number	:	239-357-5726
Fax Number	:	239-433-6706

Provider Business Practice Location Address
First Line	:	8961 DANIELS CENTER DR STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-0314
Country	:	US
Telephone Number	:	239-433-6700
Fax Number	:	239-433-6706

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	09/11/2025

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