MEDICARE: EMALEE NICOLE PASSENIER RBT

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

General Provider Information

NPI Number	:	1518685239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMALEE NICOLE PASSENIER RBT

Provider Business Mailing Address
First Line	:	PO BOX 412031
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2031
Country	:	US
Telephone Number	:	888-830-4125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 E APPLE AVE STE F
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-4281
Country	:	US
Telephone Number	:	231-354-2588
Fax Number	:	616-935-7607

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

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	01/24/2023

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