MEDICARE: AMY FESLER 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447769716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY FESLER BCBA

Provider Business Mailing Address
First Line	:	1824 TOUBY PIKE STE B
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46901-2573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 S PARK RIDGE RD STE 102
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-8589
Country	:	US
Telephone Number	:	812-822-0189
Fax Number	:

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

Provider Enumeration Date	:	09/29/2017
Last Update Date	:	12/05/2023

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