Provider Demographics
NPI:1083202980
Name:SIPLE, AMELIA L (RBT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:L
Last Name:SIPLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:AMELIA
Other - Middle Name:LORELEI
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5016 PINE NEEDLE DR
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-8854
Mailing Address - Country:US
Mailing Address - Phone:352-444-0690
Mailing Address - Fax:
Practice Address - Street 1:2138 SANDRIDGE CIR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4486
Practice Address - Country:US
Practice Address - Phone:407-579-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-143191106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician