MEDICARE: MR. SEAN HOPPER 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	103K00000X	Behavior Analyst	RBT-24-349924	CO

General Provider Information

NPI Number	:	1679392369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN HOPPER RBT

Provider Business Mailing Address
First Line	:	8674 WINDSOR HILL BLVD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8458
Country	:	US
Telephone Number	:	843-588-5677
Fax Number	:	855-632-2877

Provider Business Practice Location Address
First Line	:	8310 RIVERS AVE STE D
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9268
Country	:	US
Telephone Number	:	843-588-5677
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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