MEDICARE: MRS. NATALIE A DEVIEZ M.ED., BCBA

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	1-13-13019	GA

General Provider Information

NPI Number	:	1316382021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE A DEVIEZ M.ED., BCBA

Provider Business Mailing Address
First Line	:	1365 LYNDHURST WAY
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 LYNDHURST WAY
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-2584
Country	:	US
Telephone Number	:	770-992-8534
Fax Number	:

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

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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