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General NPI Number Information
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NPI Number | 1164771838
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Entity Type | Organization
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Legal Business Name | SUPPORTING THE SPECTRUM
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 9200 NW 14TH CT
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City | PLANTATION
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State | FL
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Zip | 33322-4308
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Country | US
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Telephone | 954-829-9018
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 NW 14TH CT
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City | PLANTATION
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State | FL
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Zip | 33322-4308
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Country | US
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Telephone | 954-829-9018
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. JOHNATHAN M KABOT
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Credential | M. ED, BCBA
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Telephone | 954-829-9018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1095153
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License Number State | FL
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