Healthcare Provider Details

I. General information

NPI: 1235982216
Provider Name (Legal Business Name): ANGELA WINDELL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

IV. Provider business mailing address

8255 W MOORESVILLE RD
CAMBY IN
46113-9215
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax: 317-845-1886
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-154177
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: