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General NPI Number Information
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NPI Number | 1245965474
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Entity Type | Individual
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Provider Name | EMMA CAROLINE QUEENER RBT
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Gender | Female
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1700 WELLS RD STE 15AND16
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City | ORANGE PARK
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State | FL
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Zip | 32073-2337
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Country | US
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Telephone | 904-412-8542
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Fax |
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Provider Business Mailing Address
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Address Line | 245 RIVER PLANTATION RD S
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-8959
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Country | US
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Telephone | 904-460-4786
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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-22-223812
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License Number State | FL
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