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NPI Code Detail

MEDICARE: KEERY L. WOLF BCBA

MEDICARE: KEERY L. WOLF BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1649439159
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEERY L. WOLF BCBA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 407-915-7729
Fax Number : 407-588-6294
Provider Business Practice Location Address
First Line : 1128 BEVILLE RD STE A
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-5769
Country : US
Telephone Number : 386-267-3161
Fax Number : 386-236-1995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2008
Last Update Date : 04/28/2023

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