MEDICARE: ANTONIA ROYAL WHITMORE

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

General Provider Information

NPI Number	:	1568122901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIA ROYAL WHITMORE

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD # 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 GRASSMERE PARK STE 1
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-3674
Country	:	US
Telephone Number	:	615-326-6578
Fax Number	:

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

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	12/27/2021

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