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NPI Code Detail

MEDICARE: MRS. KRISTEN OBERMEYER RODRIGUEZ EDS, BCBA

MEDICARE: MRS. KRISTEN OBERMEYER RODRIGUEZ EDS, BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1811267149
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEN OBERMEYER RODRIGUEZ EDS, BCBA
Provider Business Mailing Address
First Line : 556 RICHARDSON RD
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32433-6191
Country : US
Telephone Number : 850-865-0628
Fax Number : 850-892-7723
Provider Business Practice Location Address
First Line : 556 RICHARDSON RD
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32433-6191
Country : US
Telephone Number : 850-865-0628
Fax Number : 850-892-7723
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2012
Last Update Date : 01/03/2012

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