MEDICARE: OLIVIA NATIVIDAD 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	RBT20146629	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BACB578496	OTHER	TX	REGISTERED BEHAVIOR TECHNICIAN

General Provider Information

NPI Number	:	1528654407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA NATIVIDAD RBT

Provider Business Mailing Address
First Line	:	1162 W PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6367
Country	:	US
Telephone Number	:	682-308-0832
Fax Number	:	682-308-0835

Provider Business Practice Location Address
First Line	:	1162 W PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6367
Country	:	US
Telephone Number	:	682-308-0832
Fax Number	:	682-308-0835

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

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	12/15/2020

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Directions to “ OLIVIA NATIVIDAD RBT” Practice Location

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