Provider Demographics
NPI:1922580976
Name:HORST, FABIOLA MARISA (RBT-23-291351)
Entity Type:Individual
Prefix:MS
First Name:FABIOLA
Middle Name:MARISA
Last Name:HORST
Suffix:
Gender:F
Credentials:RBT-23-291351
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SCATON WAY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-6265
Mailing Address - Country:US
Mailing Address - Phone:407-572-1677
Mailing Address - Fax:
Practice Address - Street 1:155 SCATON WAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-6265
Practice Address - Country:US
Practice Address - Phone:407-572-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician