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NPI Code Detail

MEDICARE: NICHOLE O'DONNELL M.ED., BCBA

MEDICARE: NICHOLE O'DONNELL M.ED., BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst3508TX

General Provider Information

NPI Number : 1093051369
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLE O'DONNELL M.ED., BCBA
Provider Business Mailing Address
First Line : 18401 TIMBER FOREST DR
Second Line :
City : HUMBLE
State : TX
Zip : 77346-2535
Country : US
Telephone Number : 281-852-0501
Fax Number : 281-852-0502
Provider Business Practice Location Address
First Line : 18401 TIMBER FOREST DR
Second Line :
City : HUMBLE
State : TX
Zip : 77346-2535
Country : US
Telephone Number : 281-852-0501
Fax Number : 281-852-0502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2012
Last Update Date : 04/28/2022

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