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NPI Code Detail

MEDICARE: NICOLE GORDON RBT

MEDICARE: NICOLE GORDON 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 TechnicianRBT-22-200936OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-22-200936OTHEROHREGISTERED BEHAVIOR TECHNICIAN

General Provider Information

NPI Number : 1962156851
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GORDON RBT
Provider Business Mailing Address
First Line : 1628 E DOROTHY LN
Second Line :
City : KETTERING
State : OH
Zip : 45429-3810
Country : US
Telephone Number : 937-750-8236
Fax Number :
Provider Business Practice Location Address
First Line : 1628 E DOROTHY LN
Second Line :
City : KETTERING
State : OH
Zip : 45429-3810
Country : US
Telephone Number : 937-750-8236
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2022
Last Update Date : 02/09/2022

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Directions to “ NICOLE GORDON RBT” Practice Location

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