MEDICARE: LISA FEEZLE 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1225500465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FEEZLE BCBA

Provider Business Mailing Address
First Line	:	1051 TIFFANY S
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-1977
Country	:	US
Telephone Number	:	855-629-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 TIFFANY S
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-1977
Country	:	US
Telephone Number	:	855-629-6277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2018
Last Update Date	:	02/12/2024

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