=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699435297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA CRIGGER RBT-21-197635
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2021
-----------------------------------------------------
Last Update Date | 12/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7501 SLOEWOOD DR
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-399-3023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7501 SLOEWOOD DR
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-399-3023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number | RBT-21-197635
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------