MEDICARE: MRS. FIONA O'DONOVAN M.S., C.C.C. 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	222Q00000X	Developmental Therapist
2	235Z00000X	Speech-Language Pathologist	SA7792	FL
3	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S2907	OTHER	FL	BC/BS OF FLORIDA #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821187212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FIONA O'DONOVAN M.S., C.C.C. RBT

Provider Business Mailing Address
First Line	:	11910 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11910 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5601
Country	:	US
Telephone Number	:	813-350-5005
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/21/2019

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Directions to “ MRS. FIONA O'DONOVAN M.S., C.C.C. RBT” Practice Location

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