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NPI Code Detail

MEDICARE: SHAWNA R WOODLEE RBT

MEDICARE: SHAWNA R WOODLEE 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 Technician17-45772IN

General Provider Information

NPI Number : 1861964884
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWNA R WOODLEE RBT
Provider Business Mailing Address
First Line : 10820 COLDWATER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1241
Country : US
Telephone Number : 260-459-6040
Fax Number :
Provider Business Practice Location Address
First Line : 100 GROWTH PKWY STE F-G
Second Line :
City : ANGOLA
State : IN
Zip : 46703-9343
Country : US
Telephone Number : 260-459-6040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2019
Last Update Date : 01/02/2019

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Directions to “ SHAWNA R WOODLEE RBT” Practice Location

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