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NPI Code Detail

MEDICARE: COLIN PETERS

MEDICARE:   COLIN  PETERS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1235069907
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLIN PETERS
Provider Business Mailing Address
First Line : 996 ROYAL MARCO WAY
Second Line :
City : MARCO ISLAND
State : FL
Zip : 34145-1829
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9110 LEESGATE RD STE 1
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-5053
Country : US
Telephone Number : 502-242-9091
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2026
Last Update Date : 05/22/2026

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Directions to “ COLIN PETERS ” Practice Location

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