MEDICARE: ELAINE MIKEL BATTLE 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	:	1558937961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE MIKEL BATTLE RBT

Provider Business Mailing Address
First Line	:	200 GROVE PARK LN STE 110
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-5912
Country	:	US
Telephone Number	:	334-305-0297
Fax Number	:	334-777-2355

Provider Business Practice Location Address
First Line	:	200 GROVE PARK LN STE 110
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-5912
Country	:	US
Telephone Number	:	334-305-0297
Fax Number	:	334-777-2355

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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Directions to “ ELAINE MIKEL BATTLE RBT” Practice Location

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