Healthcare Provider Details

I. General information

NPI: 1518836527
Provider Name (Legal Business Name): BRANDY L CROCKETT RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N RIDGEWOOD DR
SEBRING FL
33870-7205
US

IV. Provider business mailing address

320 N RIDGEWOOD DR
SEBRING FL
33870-7205
US

V. Phone/Fax

Practice location:
  • Phone: 863-576-9091
  • Fax: 305-418-7578
Mailing address:
  • Phone: 863-576-9091
  • Fax: 305-418-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-481135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: