MEDICARE: MARSHALL JOHN WEBER RBT

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

Other Identifiers

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

General Provider Information

NPI Number	:	1063097293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL JOHN WEBER RBT

Provider Business Mailing Address
First Line	:	350 ACCEPTANCE WAY
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711
Country	:	US
Telephone Number	:	352-223-1999
Fax Number	:	352-600-3119

Provider Business Practice Location Address
First Line	:	350 ACCEPTANCE WAY
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-3471
Country	:	US
Telephone Number	:	352-223-1999
Fax Number	:	352-600-3119

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

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	03/09/2021

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Directions to “ MARSHALL JOHN WEBER RBT” Practice Location

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