MEDICARE: BEATRICE OTTOMANELLI 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	1-22-61270

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437669736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE OTTOMANELLI BCBA

Provider Business Mailing Address
First Line	:	510 AVENUE A
Second Line	:
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16415 NORTHCROSS DR STE F
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5001
Country	:	US
Telephone Number	:	704-799-6824
Fax Number	:	704-799-6825

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	12/28/2023

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Directions to “ BEATRICE OTTOMANELLI BCBA” Practice Location

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