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NPI Code Detail

MEDICARE: MARK VANDIVIER

MEDICARE: MARK VANDIVIER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1861323016
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK VANDIVIER
Provider Business Mailing Address
First Line : 100 CROWNE POINT PL
Second Line :
City : CINCINNATI
State : OH
Zip : 45241-5427
Country : US
Telephone Number : 513-743-7628
Fax Number :
Provider Business Practice Location Address
First Line : 865 S PATTERSON BLVD
Second Line :
City : DAYTON
State : OH
Zip : 45402-2624
Country : US
Telephone Number : 937-966-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ MARK VANDIVIER ” Practice Location

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