MEDICARE: MRS. MEGAN LEIGH REVOLT RBT

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	RBT-22-221527	HI

General Provider Information

NPI Number	:	1770294613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN LEIGH REVOLT RBT

Provider Business Mailing Address
First Line	:	203 SIGNER BLVD APT E
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-4900
Country	:	US
Telephone Number	:	770-710-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 SIGNER BLVD APT E
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-4900
Country	:	US
Telephone Number	:	770-710-2900
Fax Number	:

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/21/2025

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