MEDICARE: ALISON WUESTMAN

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1942785860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON WUESTMAN

Provider Business Mailing Address
First Line	:	211 S BUMBY AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-6226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1461
Country	:	US
Telephone Number	:	407-801-9925
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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