Healthcare Provider Details

I. General information

NPI: 1245992726
Provider Name (Legal Business Name): ERIN P MIKALSEN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 N SUN DR STE 112
LAKE MARY FL
32746-2599
US

IV. Provider business mailing address

PO BOX 531125
ORLANDO FL
32853-1125
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-5429
  • Fax: 321-800-7201
Mailing address:
  • Phone: 407-218-4340
  • Fax: 407-218-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-187914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: