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NPI Code Detail

MEDICARE: MISS CALLI BROOKE MARTIN BCBA

MEDICARE: MISS CALLI BROOKE MARTIN 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
1103K00000XBehavior AnalystAR

General Provider Information

NPI Number : 1336894492
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CALLI BROOKE MARTIN BCBA
Provider Business Mailing Address
First Line : 986 WELLNESS WAY STE 210
Second Line :
City : FORT MILL
State : SC
Zip : 29715-7352
Country : US
Telephone Number : 803-335-0718
Fax Number : 704-788-2016
Provider Business Practice Location Address
First Line : 986 WELLNESS WAY STE 210
Second Line :
City : FORT MILL
State : SC
Zip : 29715-7352
Country : US
Telephone Number : 803-335-0718
Fax Number : 704-788-2016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2022
Last Update Date : 06/23/2025

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Directions to “ MISS CALLI BROOKE MARTIN BCBA” Practice Location

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