MEDICARE: TIMOTHY OBERTEIN 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	:	1396160305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY OBERTEIN BCBA

Provider Business Mailing Address
First Line	:	3727 WILDER RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2367
Country	:	US
Telephone Number	:	989-992-3497
Fax Number	:	574-204-2868

Provider Business Practice Location Address
First Line	:	3727 WILDER RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2367
Country	:	US
Telephone Number	:	989-992-3497
Fax Number	:

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

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	11/18/2022

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