Healthcare Provider Details

I. General information

NPI: 1932759388
Provider Name (Legal Business Name): GRACE FRANCINE BOATMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 FERGUSON DR STE 200
ORLANDO FL
32805-1014
US

IV. Provider business mailing address

361 S GRANT ST
LONGWOOD FL
32750-5329
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-4629
  • Fax:
Mailing address:
  • Phone: 712-301-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41309
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-37240
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: