Provider Demographics
NPI:1043840499
Name:WHEELER, PAMELA A (BCBA, RBT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:F
Credentials:BCBA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CAPEN ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6003
Mailing Address - Country:US
Mailing Address - Phone:386-453-9225
Mailing Address - Fax:
Practice Address - Street 1:231 CAPEN ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6003
Practice Address - Country:US
Practice Address - Phone:386-453-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-91466106S00000X
FL1-22-62562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician