Healthcare Provider Details

I. General information

NPI: 1245141050
Provider Name (Legal Business Name): HOPE DESERAE RODWELL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 CORBIN CIR SW
PALM BAY FL
32908-8180
US

IV. Provider business mailing address

947 CORBIN CIR SW
PALM BAY FL
32908-8180
US

V. Phone/Fax

Practice location:
  • Phone: 712-355-6982
  • Fax:
Mailing address:
  • Phone: 712-355-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-517637
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: