Provider Demographics
NPI:1740905900
Name:O'REILLY, NANCY E (RBT-21-180205)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:RBT-21-180205
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 NW 154TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5814
Mailing Address - Country:US
Mailing Address - Phone:305-484-4011
Mailing Address - Fax:
Practice Address - Street 1:19161 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5255
Practice Address - Country:US
Practice Address - Phone:305-484-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-180205106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician