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General NPI Number Information
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NPI Number | 1043775299
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Entity Type | Individual
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Provider Name | CASSIDY LYNN KOEHLER
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 8001 BEATY GROVE DR
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City | TAMPA
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State | FL
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Zip | 33626-1602
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Country | US
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Telephone | 813-926-5454
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Fax | 813-920-9252
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Provider Business Mailing Address
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Address Line | 12030 HOLBROOK DR APT 8
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City | HUDSON
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State | FL
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Zip | 34667-2949
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Country | US
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Telephone | 407-738-6886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB478510
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License Number State | FL
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