Most Relevant Information
Provider Data
| NPI Number: | 1003682311 |
| Provider Name: | MICAH TONARD GREEN RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/28/2023 |
| Last Updated: | 11/28/2023 |
Provider Practice Location
4907 NW 43RD ST STE C
GAINESVILLE
FL
326062007
Practice Location Phone/Fax
| Phone: | 3523720047 |
| Fax: |
Provider Mailing Location
2308 SW 38TH DR # 112B
GAINESVILLE
FL
326072830
Provider Mailing Phone/Fax
| Phone: | 9042083314 |
| Fax: |