MEDICARE: BRE MCCALL PINDELL

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	:	1053851139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRE MCCALL PINDELL

Provider Business Mailing Address
First Line	:	1264 E 113TH AVE
Second Line	:	APT 101
City	:	TAMPA
State	:	FL
Zip	:	33612-1984
Country	:	US
Telephone Number	:	443-413-2697
Fax Number	:

Provider Business Practice Location Address
First Line	:	1264 E 113TH AVE
Second Line	:	APT 101
City	:	TAMPA
State	:	FL
Zip	:	33612-1984
Country	:	US
Telephone Number	:	443-413-2697
Fax Number	:

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

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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Directions to “ BRE MCCALL PINDELL ” Practice Location

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