Provider Demographics
NPI:1144366972
Name:MCCALL, KIMBERLY G
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:G
Last Name:MCCALL
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 1:4206 WINDING WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8637
Mailing Address - Country:US
Mailing Address - Phone:813-300-0330
Mailing Address - Fax:
Practice Address - Street 1:4206 WINDING WILLOW DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8637
Practice Address - Country:US
Practice Address - Phone:813-300-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811553200Medicaid