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NPI Code Detail

MEDICARE: MARYAM BEDELL MA-A,RBT

MEDICARE: MARYAM BEDELL MA-A,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
1101YM0800XMental Health Counselor88003185AIN
2106S00000XBehavior TechnicianRBT-21-176690IN

General Provider Information

NPI Number : 1205409588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYAM BEDELL MA-A,RBT
Provider Business Mailing Address
First Line : 1400 AIRPORT NORTH OFFICE PARK STE D
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-6723
Country : US
Telephone Number : 260-702-9141
Fax Number :
Provider Business Practice Location Address
First Line : 1400 AIRPORT NORTH OFFICE PARK STE D
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-6723
Country : US
Telephone Number : 260-702-9241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2021
Last Update Date : 02/03/2026

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