Provider Demographics
NPI:1346721578
Name:MICHAELS, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 CASA RIO CT
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6508
Mailing Address - Country:US
Mailing Address - Phone:203-376-6674
Mailing Address - Fax:
Practice Address - Street 1:3011 CASA RIO CT
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-6508
Practice Address - Country:US
Practice Address - Phone:203-376-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician