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NPI Code Detail

MEDICARE: GIDGET J MASTER RBT

MEDICARE: GIDGET J MASTER 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1568933372
Entity Type Code : Individual
Provider Name (Legal Business Name) : GIDGET J MASTER RBT
Provider Business Mailing Address
First Line : 12650 HAMILTON CROSSING BLVD
Second Line :
City : CARMEL
State : IN
Zip : 46032-5400
Country : US
Telephone Number : 317-249-2242
Fax Number : 317-663-1175
Provider Business Practice Location Address
First Line : 2555 YEAGER RD
Second Line :
City : WEST LAFAYETTE
State : IN
Zip : 47906-1335
Country : US
Telephone Number : 765-269-7756
Fax Number : 317-663-1175
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2018
Last Update Date : 12/06/2018

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Directions to “ GIDGET J MASTER RBT” Practice Location

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