MEDICARE: LYNETTE BAEZ FELICIANO 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	RBT1617695	FL

General Provider Information

NPI Number	:	1619338423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE BAEZ FELICIANO RBT

Provider Business Mailing Address
First Line	:	175 MIDDLE ST UNIT 1201
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3625
Country	:	US
Telephone Number	:	800-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	11476 S APOPKA VINELAND RD STE 118
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-7006
Country	:	US
Telephone Number	:	407-745-0738
Fax Number	:

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

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	03/17/2018

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