MEDICARE: MRS. JEANNETTE CASTILLO

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	103K00000X	Behavior Analyst	1-13-14017	AL

General Provider Information

NPI Number	:	1053753491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNETTE CASTILLO

Provider Business Mailing Address
First Line	:	495 OCOEE HILLS CIR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-4538
Country	:	US
Telephone Number	:	256-504-1894
Fax Number	:	423-370-1346

Provider Business Practice Location Address
First Line	:	495 OCOEE HILLS CIR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-4538
Country	:	US
Telephone Number	:	256-504-1894
Fax Number	:	423-370-1346

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

Provider Enumeration Date	:	07/26/2013
Last Update Date	:	03/20/2017

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Directions to “ MRS. JEANNETTE CASTILLO ” Practice Location

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