MEDICARE: VICTORIA WILMOT 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	L-1040	LA

General Provider Information

NPI Number	:	1457151649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA WILMOT BCBA

Provider Business Mailing Address
First Line	:	133 ASPEN SQ STE F
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 ASPEN SQ STE F
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5322
Country	:	US
Telephone Number	:	225-791-0617
Fax Number	:

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

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	10/31/2025

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