Healthcare Provider Details

I. General information

NPI: 1851020341
Provider Name (Legal Business Name): CELESTE EWING RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 GOODLETTE-FRANK RD N
NAPLES FL
34102-5644
US

IV. Provider business mailing address

20546 POLYNESIAN LOOP
ESTERO FL
33928-2706
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-0675
  • Fax: 393-102-0452
Mailing address:
  • Phone: 765-480-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-218711
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-218711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: