MEDICARE: KRISTEN SCHEIDMANTEL 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
1	106S00000X	Behavior Technician	RBT-19-105239	MI
2	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1154866457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN SCHEIDMANTEL RBT

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	2841 WOODCLIFF CIR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-3154
Country	:	US
Telephone Number	:	248-299-0038
Fax Number	:

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

Provider Enumeration Date	:	12/23/2016
Last Update Date	:	11/22/2019

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