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NPI Code Detail

MEDICARE: ODELL KING

MEDICARE: ODELL KING
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
1106S00000XBehavior TechnicianRBT-16-18420FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780033274
Entity Type Code : Individual
Provider Name (Legal Business Name) : ODELL KING
Provider Business Mailing Address
First Line : 4575 SE DIXIE HWY
Second Line :
City : STUART
State : FL
Zip : 34997-6826
Country : US
Telephone Number : 855-832-6727
Fax Number :
Provider Business Practice Location Address
First Line : 3730 GATLIN WOODS DR
Second Line :
City : ORLANDO
State : FL
Zip : 32812-7610
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2016
Last Update Date : 03/25/2026

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Directions to “ ODELL KING ” Practice Location

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