MEDICARE: MRS. TOVA ROTTENBERG M.ED BCBA, COBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1275102931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TOVA ROTTENBERG M.ED BCBA, COBA

Provider Business Mailing Address
First Line	:	4358 BAINTREE RD
Second Line	:
City	:	UNIVERSITY HTS
State	:	OH
Zip	:	44118-3931
Country	:	US
Telephone Number	:	216-691-0020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4358 BAINTREE RD
Second Line	:
City	:	UNIVERSITY HTS
State	:	OH
Zip	:	44118-3931
Country	:	US
Telephone Number	:	216-691-0020
Fax Number	:

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

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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