MEDICARE: AVE MARIA MICELI

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	222Q00000X	Developmental Therapist		FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1073981478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVE MARIA MICELI

Provider Business Mailing Address
First Line	:	12969 52ND RD N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-9080
Country	:	US
Telephone Number	:	732-614-7665
Fax Number	:

Provider Business Practice Location Address
First Line	:	12969 52ND RD N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-9080
Country	:	US
Telephone Number	:	732-614-7665
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	02/03/2026

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Directions to “ AVE MARIA MICELI ” Practice Location

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