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General NPI Number Information
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NPI Number | 1588019814
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Entity Type | Individual
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Provider Name | BETHANY ANAN BCABA
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Gender | Female
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Dates
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Enumeration Date | 04/23/2016
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 3730 GATLIN WOODS DR
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City | ORLANDO
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State | FL
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Zip | 32812-7610
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Country | US
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Telephone | 855-832-6727
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Fax | 772-675-9100
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Provider Business Mailing Address
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Address Line | 519 LAKEVIEW ST
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City | ORLANDO
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State | FL
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Zip | 32804-6822
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Country | US
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Telephone | 407-342-6650
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0-16-7460
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License Number State | FL
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