MEDICARE: KATHRYN MARIE SHELOW BCABA

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	106E00000X	Assistant Behavior Analyst
2	106E00000X	Assistant Behavior Analyst		FL

General Provider Information

NPI Number	:	1881233302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MARIE SHELOW BCABA

Provider Business Mailing Address
First Line	:	1902 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5903
Country	:	US
Telephone Number	:	813-250-0482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5903
Country	:	US
Telephone Number	:	813-250-0482
Fax Number	:

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

Provider Enumeration Date	:	12/31/2019
Last Update Date	:	12/31/2019

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Directions to “ KATHRYN MARIE SHELOW BCABA” Practice Location

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