MEDICARE: MATTHEW ENGEBRETHSON 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

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	:	1447728274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ENGEBRETHSON RBT

Provider Business Mailing Address
First Line	:	1160 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1461
Country	:	US
Telephone Number	:	800-676-5130
Fax Number	:	888-959-5753

Provider Business Practice Location Address
First Line	:	1160 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1461
Country	:	US
Telephone Number	:	800-676-5130
Fax Number	:	888-959-5753

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

Provider Enumeration Date	:	11/09/2018
Last Update Date	:	08/28/2020

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