Healthcare Provider Details

I. General information

NPI: 1720569247
Provider Name (Legal Business Name): MEGAN LYNN BAUMGARTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 09/29/2026
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 S FALKENBURG RD
RIVERVIEW FL
33578-2554
US

IV. Provider business mailing address

12411 TOCCI LN
RIVERVIEW FL
33579-6830
US

V. Phone/Fax

Practice location:
  • Phone: 248-935-0833
  • Fax:
Mailing address:
  • Phone: 248-935-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76716
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: