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NPI Code Detail

MEDICARE: EMALIE GENE GELLER

MEDICARE:   EMALIE GENE GELLER
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 Technician

General Provider Information

NPI Number : 1255994703
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMALIE GENE GELLER
Provider Business Mailing Address
First Line : 68 SANPATRICE CT
Second Line :
City : SMITHFIELD
State : NC
Zip : 27577-9543
Country : US
Telephone Number : 262-388-3648
Fax Number :
Provider Business Practice Location Address
First Line : 5121 KINGDOM WAY
Second Line :
City : RALEIGH
State : NC
Zip : 27607-6062
Country : US
Telephone Number : 919-390-7238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2019
Last Update Date : 04/19/2019

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Directions to “ EMALIE GENE GELLER ” Practice Location

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