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General NPI Number Information
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NPI Number | 1144062548
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Entity Type | Individual
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Provider Name | LETICIA REYES ZACKOWSKI RBT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 3997 ETERNITY CIR
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City | SAINT CLOUD
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State | FL
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Zip | 34772-8268
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Country | US
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Telephone | 321-202-6913
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Fax |
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Provider Business Mailing Address
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Address Line | 39442 COUNTY ROAD 54 # 37
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-2821
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Country | US
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Telephone | 850-741-6230
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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 | BACB1101170
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License Number State | TN
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