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General NPI Number Information
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NPI Number | 1427766682
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Entity Type | Individual
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Provider Name | TYLER MADDOX RBT
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Gender | Male
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 9 PINNACLE DR STE 105
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2367
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Country | US
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Telephone | 804-562-6604
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 PARAGON PL STE 200
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City | RICHMOND
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State | VA
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Zip | 23230-1652
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Country | US
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Telephone | 804-562-6604
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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-22-218016
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License Number State | VA
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