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NPI Code Detail

MEDICARE: MICHELET DOMINIQUE-ATHIS B.C.B.A.

MEDICARE: MICHELET DOMINIQUE-ATHIS B.C.B.A.
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 Analyst

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 : 1134529233
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELET DOMINIQUE-ATHIS B.C.B.A.
Provider Business Mailing Address
First Line : 2185 WHITE DAHLIA DR
Second Line :
City : APOPKA
State : FL
Zip : 32712-6008
Country : US
Telephone Number : 407-595-9451
Fax Number :
Provider Business Practice Location Address
First Line : 5959 LAKE ELLENOR DR
Second Line :
City : ORLANDO
State : FL
Zip : 32809-4633
Country : US
Telephone Number : 407-595-9451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2014
Last Update Date : 04/02/2025

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