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General NPI Number Information
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NPI Number | 1578251385
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Entity Type | Organization
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Legal Business Name | MARATHON AUTISM CENTER CORP
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 300 62ND STREET OCEAN
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City | MARATHON
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State | FL
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Zip | 33050-2790
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Country | US
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Telephone | 786-747-6489
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Fax | 786-524-0620
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Provider Business Mailing Address
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Address Line | 300 62ND STREET OCEAN
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City | MARATHON
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State | FL
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Zip | 33050-2790
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Country | US
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Telephone | 786-747-6489
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Fax | 786-524-0620
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Authorized Official
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Title or Position | OWNER
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Name | ODET RODRIGUEZ
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Credential | BCBA
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Telephone | 786-747-6489
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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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