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NPI Code Detail

MEDICARE: TOBIN NATHANIAL TODD MS, BCBA

MEDICARE: TOBIN NATHANIAL TODD MS, BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1053836213
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOBIN NATHANIAL TODD MS, BCBA
Provider Business Mailing Address
First Line : 2505 E JEFFERSON BLVD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46615-2635
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 505 S 3RD ST
Second Line :
City : ELKHART
State : IN
Zip : 46516-3252
Country : US
Telephone Number : 574-359-6796
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2017
Last Update Date : 04/13/2022

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