MEDICARE: ALLI DEMUTH

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	:	1659071439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLI DEMUTH

Provider Business Mailing Address
First Line	:	6214 24TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 KEENE DR
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-7248
Country	:	US
Telephone Number	:	402-368-8662
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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Directions to “ ALLI DEMUTH ” Practice Location

Language	Start Address	Practice Location

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