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NPI Code Detail

MEDICARE: BRITTANY THEBERGE M.ED., BCBA, COBA

MEDICARE: BRITTANY THEBERGE M.ED., BCBA, COBA
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 Analyst1-14-9949OH

General Provider Information

NPI Number : 1073045787
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY THEBERGE M.ED., BCBA, COBA
Provider Business Mailing Address
First Line : 16473 CRAIGMERE DR
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-6420
Country : US
Telephone Number : 216-906-9321
Fax Number :
Provider Business Practice Location Address
First Line : 24865 DETROIT RD
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-2512
Country : US
Telephone Number : 440-250-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2017
Last Update Date : 03/31/2017

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