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NPI Code Detail

MEDICARE: JILLIAN L PINO RBT

MEDICARE: JILLIAN L PINO 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1811476989
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN L PINO RBT
Provider Business Mailing Address
First Line : 2010 S YOST AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3188
Country : US
Telephone Number : 812-822-0605
Fax Number : 812-822-2496
Provider Business Practice Location Address
First Line : 2010 S YOST AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3188
Country : US
Telephone Number : 812-822-0605
Fax Number : 812-822-2496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2018
Last Update Date : 08/09/2018

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