MEDICARE: EMILY ELIZABETH ERTLE

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1043172828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ELIZABETH ERTLE

Provider Business Mailing Address
First Line	:	7500 SAN FELIPE ST STE 990
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1708
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:	866-611-1558

Provider Business Practice Location Address
First Line	:	805 E WASHINGTON ST STE 130
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3331
Country	:	US
Telephone Number	:	234-255-8531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ EMILY ELIZABETH ERTLE ” Practice Location

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