Active NPI
Michael Dettloff
- Behavior Technician
- Raleigh, NC
National Provider Identifier
1154866044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 421 Fayetteville St Ste 1100
Raleigh, NC 27601-3000 - Phone
- (888) 880-9270
- NPI assigned
- Dec 30, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
421 Fayetteville St Ste 1100
Raleigh, NC 27601-3000
Mailing address
500 Fairway Dr Ste 102
Deerfield Beach, FL 33441-1817
Phone (888) 880-9270
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483056000000",
"number": "1154866044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 FAIRWAY DR STE 102",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334411817",
"telephone_number": "888-880-9270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 FAYETTEVILLE ST STE 1100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276013000",
"telephone_number": "888-880-9270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETTLOFF",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-30",
"last_updated": "2016-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.