MEDICARE: ROBERT EBERSOLE

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	:	1669830477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT EBERSOLE

Provider Business Mailing Address
First Line	:	700 BROOKSEDGE BLVD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2820
Country	:	US
Telephone Number	:	614-882-9338
Fax Number	:

Provider Business Practice Location Address
First Line	:	4664 LARWELL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3621
Country	:	US
Telephone Number	:	614-487-7805
Fax Number	:	614-487-7809

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

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	05/06/2025

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Directions to “ ROBERT EBERSOLE ” Practice Location

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