Healthcare Provider Details

I. General information

NPI: 1841712718
Provider Name (Legal Business Name): STEFANIA COOK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS STEFANIA GIL

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2062 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4285
US

IV. Provider business mailing address

527 OCEAN PARK LN
CAPE CANAVERAL FL
32920-5303
US

V. Phone/Fax

Practice location:
  • Phone: 321-305-5576
  • Fax:
Mailing address:
  • Phone: 561-543-7019
  • Fax: 407-960-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: