Provider Demographics
NPI:1144987447
Name:FOREHAND-VAN DER LINDE, KIM (PHD, LMT)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:FOREHAND-VAN DER LINDE
Suffix:
Gender:F
Credentials:PHD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 SMALL POND RD
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-4896
Mailing Address - Country:US
Mailing Address - Phone:850-363-8897
Mailing Address - Fax:
Practice Address - Street 1:1342 TIMBERLANE RD STE 102A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1775
Practice Address - Country:US
Practice Address - Phone:850-363-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA92689225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist