Provider Demographics
NPI:1386858546
Name:DAUM, KIM (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:DAUM
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 E FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2823
Mailing Address - Country:US
Mailing Address - Phone:407-321-6428
Mailing Address - Fax:
Practice Address - Street 1:1836 BLAINE TER
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1768
Practice Address - Country:US
Practice Address - Phone:407-539-2336
Practice Address - Fax:407-644-7967
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist