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General NPI Number Information
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NPI Number | 1902603665
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Entity Type | Individual
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Provider Name | REBECCA GRIMES
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 296 S FERDON BLVD
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City | CRESTVIEW
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State | FL
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Zip | 32536-3702
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Country | US
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Telephone | 850-333-1279
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Fax |
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Provider Business Mailing Address
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Address Line | 3045 N COMMERCE PKWY
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City | MIRAMAR
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State | FL
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Zip | 33025-3927
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Country | US
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Telephone | 786-953-8500
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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-25-413372
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License Number State | FL
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