Healthcare Provider Details

I. General information

NPI: 1770197121
Provider Name (Legal Business Name): JONTAE HOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26844 TANIC DR
WESLEY CHAPEL FL
33544-4616
US

IV. Provider business mailing address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

V. Phone/Fax

Practice location:
  • Phone: 800-356-4049
  • Fax: 941-485-0519
Mailing address:
  • Phone: 800-356-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-132978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: