Provider Demographics
NPI:1497262232
Name:BAINTER, ANNETTE (RBT)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:BAINTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3804
Mailing Address - Country:US
Mailing Address - Phone:937-878-4614
Mailing Address - Fax:937-878-4719
Practice Address - Street 1:919 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3804
Practice Address - Country:US
Practice Address - Phone:937-878-4614
Practice Address - Fax:937-878-4719
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16-12297106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
16-12297OtherREGISTERED BEHAVIOR TECHNICIAN