MEDICARE: TOBEY JAMISON BROWN 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	RBT-20-134639	FL

General Provider Information

NPI Number	:	1619582277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOBEY JAMISON BROWN RBT

Provider Business Mailing Address
First Line	:	1618 PORTCASTLE CIR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4746
Country	:	US
Telephone Number	:	574-206-3309
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 WHITE SANDERLING CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-0823
Country	:	US
Telephone Number	:	813-407-7275
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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