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NPI Code Detail

MEDICARE: ELIZABTH KATHERINE SEPULVEDA

MEDICARE: ELIZABTH KATHERINE SEPULVEDA
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 TechnicianRBT-22-210301GA

General Provider Information

NPI Number : 1912644014
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABTH KATHERINE SEPULVEDA
Provider Business Mailing Address
First Line : 7491 MOSSDALE WAY
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-1787
Country : US
Telephone Number : 850-266-4697
Fax Number :
Provider Business Practice Location Address
First Line : 7491 MOSSDALE WAY
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-1787
Country : US
Telephone Number : 850-266-4697
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2022
Last Update Date : 05/19/2022

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Directions to “ ELIZABTH KATHERINE SEPULVEDA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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