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NPI Code Detail

MEDICARE: MIKAYLA R CODY RBT

MEDICARE: MIKAYLA R CODY RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-17-33802IN
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1013416254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAYLA R CODY RBT
Provider Business Mailing Address
First Line : 1981 LEWIS TURNER BLVD
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-1256
Country : US
Telephone Number : 850-607-6910
Fax Number : 850-607-6932
Provider Business Practice Location Address
First Line : 1981 LEWIS TURNER BLVD
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-1256
Country : US
Telephone Number : 850-607-6910
Fax Number : 850-607-6932
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2018
Last Update Date : 04/03/2021

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Directions to “ MIKAYLA R CODY RBT” Practice Location

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