Healthcare Provider Details

I. General information

NPI: 1700792587
Provider Name (Legal Business Name): EMMALEE LEWIS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 AVENUE D ST
GREENCASTLE IN
46135-1839
US

IV. Provider business mailing address

1135 AVENUE D ST
GREENCASTLE IN
46135-1839
US

V. Phone/Fax

Practice location:
  • Phone: 765-655-3604
  • Fax: 765-655-3604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2836445
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: