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General NPI Number Information
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NPI Number | 1831788959
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Entity Type | Individual
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Provider Name | JORDAN DOUGLAS DAILEY RBT
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Gender | Male
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 7413 SQUIRE CT
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City | WEST CHESTER
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State | OH
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Zip | 45069-2313
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Country | US
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Telephone | 513-847-4685
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Fax | 513-847-4763
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Provider Business Mailing Address
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Address Line | 2 VILLAGE SQ STE 210
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City | BALTIMORE
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State | MD
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Zip | 21210-1624
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Country | US
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Telephone | 513-847-4685
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Fax | 513-847-4763
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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-23-290942
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License Number State | IN
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