Provider Demographics
NPI:1063064251
Name:KIMBERLEY GALLET DE ST AURIN
Entity type:Organization
Organization Name:KIMBERLEY GALLET DE ST AURIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ITDS
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLET DE ST AURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-309-6490
Mailing Address - Street 1:2817 NW 41ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1543
Mailing Address - Country:US
Mailing Address - Phone:954-309-6490
Mailing Address - Fax:
Practice Address - Street 1:2817 NW 41ST PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1543
Practice Address - Country:US
Practice Address - Phone:954-309-6490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty