MEDICARE: JANICE COLON

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	:	1598209256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE COLON

Provider Business Mailing Address
First Line	:	175 MIDDLE ST
Second Line	:	SUITE 1201
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3625
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	10920 MOSS PARK ROAD
Second Line	:	SUITE 100
City	:	ORLANDO
State	:	FL
Zip	:	32832-6087
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

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

Provider Enumeration Date	:	12/14/2016
Last Update Date	:	12/14/2016

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Directions to “ JANICE COLON ” Practice Location

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