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NPI Code Detail

MEDICARE: HAEJOO THOMAS BCBA

MEDICARE: HAEJOO THOMAS BCBA
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
1106S00000XBehavior TechnicianRBT-22-245756FL
2103K00000XBehavior Analyst1-25-81431

Other Identifiers

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

General Provider Information

NPI Number : 1104536390
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAEJOO THOMAS BCBA
Provider Business Mailing Address
First Line : PO BOX 259
Second Line :
City : SHALIMAR
State : FL
Zip : 32579-0259
Country : US
Telephone Number : 850-362-6824
Fax Number :
Provider Business Practice Location Address
First Line : 410 W NINE MILE RD STE C
Second Line :
City : PENSACOLA
State : FL
Zip : 32534-1954
Country : US
Telephone Number : 850-362-6824
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2022
Last Update Date : 05/22/2025

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