SHANNON L. MARIS (NPI# 1821601873) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821601873 |
| Entity Type | Individual |
| Full Name | SHANNON L. MARIS |
| Practice Address |
419 Racetrack Rd Nw Fort Walton Beach FL 32547-4612 |
| Practice Telephone | 8503626824 |
| Mailing Telephone | 8503626824 |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | RBT-19-99956 | FL | Behavioral Health & Social Service Providers |
| Street Address |
419 RACETRACK RD NW |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-4612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578858452 | Susan Renee Gillespie | Nurse Practitioner | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2011-06-18 |
| 1316548852 | Kay Robinson | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2020-11-02 |
| 1710593348 | Lilli Katherine Wilkinson | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2020-09-18 |
| 1720691835 | Angela Patricia Vaughn | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2020-08-28 |
| 1053974527 | Kayla Williams | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2019-04-19 |
| 1386100378 | Haley Kay Meyer | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2019-02-14 |
| 1386129658 | Michelle L Chumbley | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2018-10-02 |
| 1215414529 | Mallory E Amrhein | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2018-07-20 |
| 1649760968 | Timothy H Bulger IIi | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2018-05-11 |
| 1053808154 | Megan Wolter | Behavioral Analyst | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2018-04-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1790292837 | David Wells | Behavior Technician | 103a Lewis St, Fort Walton Beach, FL 32547-3142 | 2018-01-10 |
| 1164930202 | Aaliyah Sade Soanes | Behavior Technician | 103 Lewis St Fl 32547, Fort Walton Beach, FL 32547-3142 | 2018-01-10 |
| 1134636699 | Keyahria Butler | Behavior Technician | 1981 Lewis Turner Blvd, Fort Walton Beach, FL 32547-1256 | 2018-01-05 |
| 1730604695 | Camille Martinez | Behavior Technician | 116 Fourth St Se Unit #c, Fort Walton Beach, FL 32569 | 2017-08-11 |
| 1003336462 | Elizabeth Irene Hart | Behavior Technician | 116 4th St Se, Fort Walton Beach, FL 32548-5425 | 2017-06-26 |
| 1528597598 | Evelyn Ramos | Behavior Technician | 116 4th St Se Unit C, Fort Walton Beach, FL 32548-5438 | 2017-06-05 |
| 1316548852 | Kay Robinson | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2020-11-02 |
| 1710593348 | Lilli Katherine Wilkinson | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2020-09-18 |
| 1720691835 | Angela Patricia Vaughn | Behavior Technician | 419 Racetrack Rd Nw, Fort Walton Beach, FL 32547-4612 | 2020-08-28 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.