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NPI Code Detail

MEDICARE: BRANDI DIXON RBT

MEDICARE: BRANDI DIXON RBT
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-22-212088IN

General Provider Information

NPI Number : 1134827942
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI DIXON RBT
Provider Business Mailing Address
First Line : 11401 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2349
Country : US
Telephone Number : 888-515-1793
Fax Number : 502-297-0289
Provider Business Practice Location Address
First Line : 4410 EXECUTIVE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46808-1135
Country : US
Telephone Number : 888-515-1793
Fax Number : 502-297-0289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 02/21/2023

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