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General NPI Number Information
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NPI Number | 1740893189
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Entity Type | Individual
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Provider Name | MATTHEW WILLIAM OLDS RBT
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Gender | Male
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 9038 CROSS PARK DR STE 105
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City | KNOXVILLE
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State | TN
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Zip | 37923-4729
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Country | US
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Telephone | 865-394-6612
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Fax |
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Provider Business Mailing Address
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Address Line | 9038 CROSS PARK DR STE 105
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City | KNOXVILLE
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State | TN
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Zip | 37923-4729
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Country | US
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Telephone | 865-394-6612
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-80383
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | LABA35
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License Number State | TN
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