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NPI Code Detail

MEDICARE: MAIRA DE WITT RBT

MEDICARE: MAIRA DE WITT 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1932699626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAIRA DE WITT RBT
Provider Business Mailing Address
First Line : 1599 TOWNSHIP LINE RD
Second Line :
City : PLAINFIELD
State : IN
Zip : 46168-7517
Country : US
Telephone Number : 317-914-3176
Fax Number :
Provider Business Practice Location Address
First Line : 1599 TOWNSHIP LINE RD
Second Line :
City : PLAINFIELD
State : IN
Zip : 46168-7517
Country : US
Telephone Number : 317-914-3176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2018
Last Update Date : 05/17/2018

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Directions to “ MAIRA DE WITT RBT” Practice Location

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