Healthcare Provider Details

I. General information

NPI: 1265114151
Provider Name (Legal Business Name): DESIREE MARIE GELFENSTEIN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 TECH BLVD STE 122
TAMPA FL
33619-7822
US

IV. Provider business mailing address

5312 HILLSBOROUGH CIR
TAMPA FL
33610-9749
US

V. Phone/Fax

Practice location:
  • Phone: 813-305-2887
  • Fax: 177-267-5910
Mailing address:
  • Phone: 813-362-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-6829-423368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: