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NPI Code Detail

MEDICARE: DEVON ROACH RBT

MEDICARE: DEVON ROACH RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-26-516559KY

General Provider Information

NPI Number : 1023963329
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVON ROACH RBT
Provider Business Mailing Address
First Line : 257 EM HURLEY LN
Second Line :
City : CALVERT CITY
State : KY
Zip : 42029-8874
Country : US
Telephone Number : 270-444-7898
Fax Number : 270-933-1786
Provider Business Practice Location Address
First Line : 619 N 30TH ST
Second Line :
City : PADUCAH
State : KY
Zip : 42001-4047
Country : US
Telephone Number : 270-444-7898
Fax Number : 270-933-1786
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ DEVON ROACH RBT” Practice Location

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