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NPI Code Detail

MEDICARE: BROOKE HATTEN

MEDICARE: BROOKE HATTEN
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 Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023502275
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE HATTEN
Provider Business Mailing Address
First Line : 175 MIDDLE ST UNIT 1201
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-3625
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 2100 N ALAFAYA TRL
Second Line :
City : ORLANDO
State : FL
Zip : 32826-4710
Country : US
Telephone Number : 407-720-4101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2018
Last Update Date : 06/20/2018

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Directions to “ BROOKE HATTEN ” Practice Location

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