Healthcare Provider Details

I. General information

NPI: 1851957757
Provider Name (Legal Business Name): DONNA ZUHLKE BEHAVIOR TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 FORT JACKSON CT
MILTON FL
32583-7692
US

IV. Provider business mailing address

6810 FORT JACKSON CT
MILTON FL
32583-7692
US

V. Phone/Fax

Practice location:
  • Phone: 850-503-6636
  • Fax: 850-626-6132
Mailing address:
  • Phone: 850-503-6636
  • Fax: 850-626-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-86439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: