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General NPI Number Information
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NPI Number | 1396274320
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Entity Type | Individual
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Provider Name | ERLINE THELOT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2017
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Last Update Date | 06/04/2017
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Provider Practice Location Address
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Address Line | 115 SW 1ST AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4465
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Country | US
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Telephone | 561-563-0509
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Fax |
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Provider Business Mailing Address
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Address Line | 415 SW 6TH AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-5521
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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