Provider Demographics
NPI:1568978807
Name:RODAMAKER, ABIGAIL (BCBA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:RODAMAKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6223 HIGHWAY 90 UNIT 174
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-1705
Mailing Address - Country:US
Mailing Address - Phone:850-686-0726
Mailing Address - Fax:
Practice Address - Street 1:7032 FLINTWOOD STREET
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566
Practice Address - Country:US
Practice Address - Phone:850-686-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-1620244106S00000X
1-18-30360103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician