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General NPI Number Information
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NPI Number | 1487304127
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Entity Type | Individual
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Provider Name | REBECCA TEDDER
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Gender | Female
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 2385 NW EXECUTIVE CENTER DR STE 100
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City | BOCA RATON
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State | FL
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Zip | 33431-8510
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Country | US
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Telephone | 561-847-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 109 GRANTHAM A
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-3401
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Country | US
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Telephone | 917-991-4488
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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 | 374700000X
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Taxonomy Name | Technician
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License Number | APF-1646329888-25666
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | APF-164632988825666
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License Number State | CA
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