Healthcare Provider Details

I. General information

NPI: 1245127778
Provider Name (Legal Business Name): MICHAEL DAMON GEIGER RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 S MICHIGAN AVE STE 900
CHICAGO IL
60604-4393
US

IV. Provider business mailing address

314 CONLIN AVE
SYCAMORE IL
60178-3002
US

V. Phone/Fax

Practice location:
  • Phone: 813-395-1073
  • Fax: 772-675-9100
Mailing address:
  • Phone: 815-901-5010
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-394607
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: