MEDICARE: MRS. ASIA ARIEL CULBRETH

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	222Q00000X	Developmental Therapist		FL

General Provider Information

NPI Number	:	1558722058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASIA ARIEL CULBRETH

Provider Business Mailing Address
First Line	:	8961 DANIELS CENTER DR STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-0314
Country	:	US
Telephone Number	:	727-871-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	9445 IVY BROOK RUN APT 1110
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-7767
Country	:	US
Telephone Number	:	727-871-5345
Fax Number	:

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

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	08/19/2020

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