MEDICARE: MRS. ALEXANDRA DIANNE TOMEI LBA, 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	1-14-17142	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BA60767196	OTHER	WA	WASHINGTON DOH
2	1-14-17142	OTHER	CO	BEHAVIOR ANALYST CERTIFICATION BOARD
3	0133000817	OTHER	VA	VIRGINIA DOH

General Provider Information

NPI Number	:	1386999530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA DIANNE TOMEI LBA, BCBA

Provider Business Mailing Address
First Line	:	30875 SR 20
Second Line	:	B-1
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-7534
Country	:	US
Telephone Number	:	360-600-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	31955 SR 20
Second Line	:	SUITE 3
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-5211
Country	:	US
Telephone Number	:	360-279-9000
Fax Number	:	180-099-1607

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

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	02/12/2018

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