MEDICARE: KIMBERLY DANIELLE HURLEY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1942793286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DANIELLE HURLEY

Provider Business Mailing Address
First Line	:	1086 LOVELY LN
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-4231
Country	:	US
Telephone Number	:	217-891-4359
Fax Number	:

Provider Business Practice Location Address
First Line	:	6844 INTERNATIONAL CENTER BLVD STE 500
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7159
Country	:	US
Telephone Number	:	800-217-9289
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	06/12/2018

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Directions to “ KIMBERLY DANIELLE HURLEY ” Practice Location

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