MEDICARE: MISS ALEXANDRA DANIELLE SEALE

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	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1396577706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALEXANDRA DANIELLE SEALE

Provider Business Mailing Address
First Line	:	905 ROBERTS CUT OFF RD
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-2825
Country	:	US
Telephone Number	:	817-731-2293
Fax Number	:

Provider Business Practice Location Address
First Line	:	6110 MADOC FORK DR APT 1136
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5882
Country	:	US
Telephone Number	:	817-999-3049
Fax Number	:

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

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/14/2024

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