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General NPI Number Information
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NPI Number | 1104279017
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Entity Type | Individual
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Provider Name | ELODIE JEAN-BAPTISTE
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Gender | Female
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 17773 SW 2ND ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3924
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Country | US
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Telephone | 954-668-9859
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Fax |
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Provider Business Mailing Address
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Address Line | 16792 NW 20TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2014
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Country | US
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Telephone | 954-895-1740
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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 | RBT-16-17382
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | RBT-16-17382
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License Number State | FL
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