Provider Demographics
NPI:1710317243
Name:KIMBLE, ALTERMEASE S
Entity Type:Individual
Prefix:
First Name:ALTERMEASE
Middle Name:S
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 N ORANGE BLOSSOM TRL STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1016
Mailing Address - Country:US
Mailing Address - Phone:407-879-3951
Mailing Address - Fax:407-286-2980
Practice Address - Street 1:5104 N ORANGE BLOSSOM TRL STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1016
Practice Address - Country:US
Practice Address - Phone:407-879-3951
Practice Address - Fax:407-286-2980
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF113657588001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113657588OtherEIN