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General NPI Number Information
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NPI Number | 1346053220
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Entity Type | Individual
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Provider Name | MADISON SPENCER RBT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1022 E 52ND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-1205
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Country | US
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Telephone | 317-815-5501
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Fax | 317-815-3861
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Provider Business Mailing Address
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Address Line | 9471 W QUARTER MOON DR
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City | PENDLETON
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State | IN
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Zip | 46064-8570
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Country | US
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Telephone |
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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-23-254595
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License Number State | IN
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