Healthcare Provider Details

I. General information

NPI: 1679006506
Provider Name (Legal Business Name): TEACHING INTERVENTIONS KEEPING INDIVIDUALITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HIBISCUS BLVD
MERRITT ISLAND FL
32952-5070
US

IV. Provider business mailing address

415 HIBISCUS BLVD
MERRITT ISLAND FL
32952-5070
US

V. Phone/Fax

Practice location:
  • Phone: 321-961-7831
  • Fax: 407-960-3009
Mailing address:
  • Phone: 321-961-7831
  • Fax: 407-960-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TIKI FIOL
Title or Position: OWNER
Credential:
Phone: 321-961-7831