MEDICARE: BETTY MAXON

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1952811853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY MAXON

Provider Business Mailing Address
First Line	:	12995 S CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12995 S CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3890
Country	:	US
Telephone Number	:	239-672-4536
Fax Number	:

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

Provider Enumeration Date	:	10/05/2017
Last Update Date	:	10/05/2017

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Directions to “ BETTY MAXON ” Practice Location

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