Provider Demographics
NPI:1205016334
Name:NEALE, KIM ELAINE (LMT)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:ELAINE
Last Name:NEALE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5222
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-5222
Mailing Address - Country:US
Mailing Address - Phone:352-207-3887
Mailing Address - Fax:
Practice Address - Street 1:611 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7033
Practice Address - Country:US
Practice Address - Phone:352-207-3887
Practice Address - Fax:352-369-1122
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist