DOMINIQUE M POULTER (NPI# 1902429855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902429855 |
| Entity Type | Individual |
| Full Name | DOMINIQUE M POULTER |
| Practice Address |
2565 N Toledo Blade Blvd North Port FL 34289-9306 |
| Mailing Address |
5 Revere Dr Ste 120 Northbrook IL 60062-8005 |
| Practice Telephone | 8478076647 |
| Practice Fax Number | 9414850519 |
| Mailing Telephone | 8478076647 |
| Mailing Fax Number | 8473483706 |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2020-05-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | RBT-20-119759 | FL | Behavioral Health & Social Service Providers |
| Street Address |
2565 N TOLEDO BLADE BLVD |
| City | NORTH PORT |
| State | FL |
| Zip Code | 34289-9306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578698346 | Daniela Sodre | Speech-Language Pathologist | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2007-02-22 |
| 1316551765 | Heather Sifford | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2020-09-03 |
| 1619590460 | Cassie Wills | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2020-05-27 |
| 1992328819 | Jennifer Charles | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2020-05-27 |
| 1619504891 | Brittany Rivera | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2020-03-26 |
| 1649805227 | Rebecca Orre | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2020-03-04 |
| 1649813866 | Stefanie M Limona | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2019-10-21 |
| 1740830884 | Savanna Spagnoli | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2019-09-19 |
| 1760031264 | Amber Ledford | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2019-09-06 |
| 1255990842 | Mary Miles | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2019-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477085439 | Heather Proctor | Counselor | 2571 N Toledo Blade Blvd Unit 3, North Port, FL 34289 | 2017-03-29 |
| 1649538281 | Lisa Beth Gussin | Counselor | 2562 Commerce Parkway, North Port, FL 34289 | 2012-05-02 |
| 1790090538 | Flagel Pediatric & Family Medicine P A | Clinic/Center | 2572 Commerce Parkway, North Port, FL 34289 | 2010-08-17 |
| 1427101773 | Belinda Alma | Counselor | 2564 Commerce Pkwy., Suite 1, North Port, FL 34289 | 2007-01-19 |
| 1659477727 | Mark C Burne | Dentist | 2787 Sycamore St, Building F, Suite 106, North Port, FL 34289 | 2006-09-16 |
| 1710119177 | North Port Oral Surgery Inc. | Clinic/Center | 2787 Sycamore St, Building F, Suite 106, North Port, FL 34289 | 2009-08-19 |
| 1184885014 | Maytal Adlersberg | Physical Therapy Assistant | 2334 Rosewood Ln, North Port, FL 34289-1404 | 2008-06-23 |
| 1588820195 | Sheri Chejlyk | Social Worker | 2562 Commerce Pkwy, North Port, FL 34289-9328 | 2008-08-03 |
| 1417294810 | Randy L Walchle | Counselor | 2562 Commerce Pkwy, North Port, FL 34289-9328 | 2013-01-07 |
| 1932515376 | Imagine Neuromuscular Therapy Center Inc | Specialist | 2568 Commerce Pkwy, North Port, FL 34289-9329 | 2014-07-07 |
| Find all providers in zip 34289 | ||||
| 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 |
|---|---|---|---|---|
| 1821602699 | Andre Coleman | Behavior Technician | 3347 Moravia Ave, North Port, FL 34286-5216 | 2020-08-31 |
| 1134764087 | Michelle Lee Farnsworth | Behavior Technician | 4969 Hader Rd, North Port, FL 34288-8383 | 2019-11-14 |
| 1316589930 | Daimon A Glenn | Behavior Technician | 3723 Cinderella Rd, North Port, FL 34286-2066 | 2019-10-15 |
| 1083180285 | Shelby Katherine Chirillo | Behavior Technician | 2500 Bobcat Center, Suite G, North Port, FL 34223 | 2018-10-16 |
| 1508347527 | Jessica Robinson | Behavior Technician | 5611 Quartz Ter, North Port, FL 34288-4525 | 2018-08-27 |
| 1235625310 | Christina M Clayton | Behavior Technician | 4243 Kiska Rd, North Port, FL 34288-6362 | 2018-07-02 |
| 1699269357 | Brittani Lynn Bunkley | Behavior Technician | 1131 Ohana Way Unit 306, North Port, FL 34289-9442 | 2018-06-17 |
| 1316551765 | Heather Sifford | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2020-09-03 |
| 1386253292 | Carly Joy Sharpsteen | Behavior Technician | 2500 Bobcat Village Center Rd Unit G, North Port, FL 34288-8476 | 2020-07-27 |
| 1619590460 | Cassie Wills | Behavior Technician | 2565 N Toledo Blade Blvd, North Port, FL 34289-9306 | 2020-05-27 |
| Find all providers in NORTH PORT | ||||
| City | NORTH PORT |
| Zip Code | 34289 |
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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.