Healthcare Provider Details

I. General information

NPI: 1477464220
Provider Name (Legal Business Name): AUTUMN CHATTERTON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 W BEACON RD
LAKELAND FL
33803-2847
US

IV. Provider business mailing address

1516 TEAKWOOD DR
PLANT CITY FL
33563-7859
US

V. Phone/Fax

Practice location:
  • Phone: 863-220-1205
  • Fax:
Mailing address:
  • Phone: 509-793-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-230507
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: