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General NPI Number Information
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NPI Number | 1578416806
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Entity Type | Individual
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Provider Name | CHELLC NICOLE MYERS RBT
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Gender | Female
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Dates
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Enumeration Date | 02/17/2026
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 63 2ND AVE
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City | SHALIMAR
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State | FL
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Zip | 32579-2163
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Country | US
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Telephone | 850-687-9183
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Fax | 850-360-8185
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Provider Business Mailing Address
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Address Line | 1333 COLLEGE PKWY # 1020
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City | GULF BREEZE
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State | FL
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Zip | 32563-2711
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Country | US
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Telephone | 850-687-9183
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Fax | 850-360-8185
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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 | BACB1521724
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License Number State | FL
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