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General NPI Number Information
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NPI Number | 1962221911
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Entity Type | Individual
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Provider Name | MADISON DOTTERWEICH RBT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 77 W FAIRMONT AVE
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City | SAVANNAH
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State | GA
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Zip | 31406-3450
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Country | US
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Telephone | 912-221-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 146 GLENN BRYANT RD
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City | HINESVILLE
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State | GA
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Zip | 31313-5313
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Country | US
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Telephone |
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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 | RBT-22-4675-423079
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License Number State | IN
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