Individual
COATTIE SIVADON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
5750 FALLS DR, FORT WAYNE, IN 46804-7147
(260) 204-5719
Mailing address
5750 FALLS DR, FORT WAYNE, IN 46804-7147
(260) 204-5719
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-445439
IN
Other
Enumeration date
08/29/2025
Last updated
08/29/2025
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