MEDICARE: COLLEEN WILSON RBT

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	106S00000X	Behavior Technician	RBT-20-133651	IN

General Provider Information

NPI Number	:	1417531898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN WILSON RBT

Provider Business Mailing Address
First Line	:	2871 N TALLEY RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-9169
Country	:	US
Telephone Number	:	812-344-3885
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 W JACKSON ST STE B&C
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-1295
Country	:	US
Telephone Number	:	317-512-2101
Fax Number	:

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

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	03/17/2022

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Directions to “ COLLEEN WILSON RBT” Practice Location

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