Provider Demographics
NPI:1316064702
Name:DODSON, KIM MARIE (BA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:DODSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:RABCZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1501 SE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-6713
Mailing Address - Country:US
Mailing Address - Phone:239-357-5726
Mailing Address - Fax:239-433-6706
Practice Address - Street 1:8961 DANIELS CENTER DR STE 401
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0314
Practice Address - Country:US
Practice Address - Phone:239-433-6700
Practice Address - Fax:239-433-6706
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist