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General NPI Number Information
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NPI Number | 1548822281
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Entity Type | Individual
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Provider Name | MICHAEL W ICE BCBA
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Gender | Male
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 2084 MEADOWLANE AVE
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-4950
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Country | US
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Telephone | 321-209-0242
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Fax |
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Provider Business Mailing Address
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Address Line | 812 KALEY PL
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-7319
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Country | US
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Telephone | 321-987-2929
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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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