MEDICARE: AVA NOEL BOTHEL

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	:	1669315784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA NOEL BOTHEL

Provider Business Mailing Address
First Line	:	16700 17 MILE RD
Second Line	:	SUITE A
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038
Country	:	US
Telephone Number	:	586-228-2300
Fax Number	:	586-228-2300

Provider Business Practice Location Address
First Line	:	16700 17 MILE RD
Second Line	:	SUITE A
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038
Country	:	US
Telephone Number	:	586-228-2300
Fax Number	:	586-228-2300

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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