MEDICARE: MRS. CHARLY NOTTKE

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	RBT-26-541941	FL

General Provider Information

NPI Number	:	1083546188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLY NOTTKE

Provider Business Mailing Address
First Line	:	PO BOX 10827
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32302-2827
Country	:	US
Telephone Number	:	850-521-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 WELLINGTON CIR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-6887
Country	:	US
Telephone Number	:	850-521-1973
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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