Active NPI
Austin Michael Marzolph
- Behavior Technician
- Middleburg, FL
National Provider Identifier
1689154114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-18-62762
- Practice address
- 1635 Farm Way
Middleburg, FL 32068-7769 - Phone
- (850) 607-6910
- Fax
- (850) 607-6932
- NPI assigned
- Aug 15, 2018
- Sex
- Male
- Sole proprietor
- No
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 | RBT-18-62762 | FL | Primary |
Addresses
Primary practice location
1635 Farm Way
Middleburg, FL 32068-7769
Mailing address
3771 Stefani Rd
Cantonment, FL 32533-7795
Phone (850) 607-6910
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-18-62762 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534291200000",
"number": "1689154114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3771 STEFANI RD",
"city": "CANTONMENT",
"state": "FL",
"postal_code": "325337795",
"telephone_number": "850-607-6910",
"fax_number": "850-607-6932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1635 FARM WAY",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320687769",
"telephone_number": "850-607-6910",
"fax_number": "850-607-6932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARZOLPH",
"first_name": "AUSTIN",
"middle_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-15",
"last_updated": "2018-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-18-62762",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.