MEDICARE: TREVOR XAVIER WITTA

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

General Provider Information

NPI Number	:	1083378624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR XAVIER WITTA

Provider Business Mailing Address
First Line	:	1570 N PROSPECT AVE APT 1006
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2322
Country	:	US
Telephone Number	:	317-403-9933
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 N MILWAUKEE ST # 355
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3724
Country	:	US
Telephone Number	:	317-403-9933
Fax Number	:

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

Provider Enumeration Date	:	10/29/2021
Last Update Date	:	10/29/2021

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Directions to “ TREVOR XAVIER WITTA ” Practice Location

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