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General NPI Number Information
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NPI Number | 1447766894
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Entity Type | Individual
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Provider Name | GABRIELLE MEGAN WUTTKE RBT
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Gender | Female
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 2145 NE 164TH ST APT 824
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162
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Country | US
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Telephone | 305-321-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 NE 164TH ST APT 824
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4298
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Country | US
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Telephone | 305-321-5008
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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-16-20551
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License Number State | VA
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