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NPI Code Detail

MEDICARE: POLLY ANN MCMILLAN BCBA

MEDICARE: POLLY ANN MCMILLAN BCBA
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
1103K00000XBehavior Analyst1-19-37619FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770103590
Entity Type Code : Individual
Provider Name (Legal Business Name) : POLLY ANN MCMILLAN BCBA
Provider Business Mailing Address
First Line : 6226 W BAGHDAD ST
Second Line :
City : DUNNELLON
State : FL
Zip : 34433-6512
Country : US
Telephone Number : 352-445-7486
Fax Number :
Provider Business Practice Location Address
First Line : 130 HEIGHTS AVE
Second Line :
City : INVERNESS
State : FL
Zip : 34452-4571
Country : US
Telephone Number : 352-419-6570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2020
Last Update Date : 02/19/2024

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