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General NPI Number Information
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NPI Number | 1942881016
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Entity Type | Individual
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Provider Name | EMMALYNN RUPERT WOMACK
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Gender | Female
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 495 GRAND BLVD STE 206
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-1897
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Country | US
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Telephone | 855-832-6727
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Fax | 772-675-9100
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Provider Business Mailing Address
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Address Line | 4765 CARLYN DR
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City | MILTON
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State | FL
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Zip | 32571-9019
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Country | US
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Telephone | 850-736-3366
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-83772
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License Number State | FL
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