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General NPI Number Information
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NPI Number | 1861329179
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Entity Type | Individual
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Provider Name | NICHOLE ROSE GARY RBT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 793 N ALMA SCHOOL RD
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City | CHANDLER
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State | AZ
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Zip | 85224-3681
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Country | US
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Telephone | 602-461-8463
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Fax |
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Provider Business Mailing Address
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Address Line | 685 E FAIRWAY DR
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4442
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Country | US
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Telephone | 602-739-3453
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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-26-529399
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License Number State | AZ
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