=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992665061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADILYN FRYE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 W MICHIGAN AVE STE 18
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32526-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-730-7418
-----------------------------------------------------
Fax | 850-403-0007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9644 HOLLOWBROOK DR
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32514-1613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-266-5300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | BACB1456730
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------