Healthcare Provider Details

I. General information

NPI: 1114784089
Provider Name (Legal Business Name): BROOKE TAYLOR ESPOSITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12244 E 116TH ST
FISHERS IN
46037-6901
US

IV. Provider business mailing address

7901 E 88TH ST
INDIANAPOLIS IN
46256-1235
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-87040
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-134719
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: