Healthcare Provider Details

I. General information

NPI: 1316352966
Provider Name (Legal Business Name): ALYCIA MARIE O'DELL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2062 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4285
US

IV. Provider business mailing address

460 GATEWAY DR
MERRITT ISLAND FL
32952-2652
US

V. Phone/Fax

Practice location:
  • Phone: 321-305-5576
  • Fax:
Mailing address:
  • Phone: 407-375-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number60958589
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: