Most Relevant Information
Provider Data
| NPI Number: | 1003336462 |
| Provider Name: | ELIZABETH IRENE HART RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-17-35933 |
Most Important Dates
| Enumeration Date: | 06/26/2017 |
| Last Updated: | 06/26/2017 |
Provider Practice Location
116 4TH ST SE
FORT WALTON BEACH
FL
325485425
Practice Location Phone/Fax
| Phone: | 8503689373 |
| Fax: |
Provider Mailing Location
305 PINE MOSS DR
FORT WALTON BEACH
FL
325486307
Provider Mailing Phone/Fax
| Phone: | 8504960155 |
| Fax: |