MEDICARE: TORI ALEXANDRA PHELPS

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	1-18-30709	IN

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	:	1659852101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORI ALEXANDRA PHELPS

Provider Business Mailing Address
First Line	:	3384 BEACON DR
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-8593
Country	:	US
Telephone Number	:	812-664-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 BOBCAT VILLAGE CENTER RD UNIT G
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8476
Country	:	US
Telephone Number	:	812-664-4312
Fax Number	:

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

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	01/10/2025

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