1134628365 NPI number — BRANDI COY RBT

Table of content: BRANDI COY RBT (NPI 1134628365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134628365 NPI number — BRANDI COY RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COY
Provider First Name:
BRANDI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134628365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 N 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORMLEYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-588-4222
Provider Business Mailing Address Fax Number:
717-775-3443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 N 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORMLEYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-588-4222
Provider Business Practice Location Address Fax Number:
717-775-3443
Provider Enumeration Date:
02/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-18-47642 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RBT-18-47642 . This is a "APPLIED BEHAVIOR ANALYSIS - REGISTERED BEHAVIOR TECHNICIAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".