Provider Demographics
NPI:1407014210
Name:DOYLE, KIM MARIE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 BLACKBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1424
Mailing Address - Country:US
Mailing Address - Phone:407-891-1084
Mailing Address - Fax:407-957-7039
Practice Address - Street 1:3815 BLACKBERRY CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1424
Practice Address - Country:US
Practice Address - Phone:407-891-1084
Practice Address - Fax:407-957-7039
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist