MEDICARE: AUTISM THERAPEUTIC SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	261QM1300X	Multi-Specialty Clinic/Center
6	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1063161891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	568 SANDHURST DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2357 WARM SPRINGS RD STE 119
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5668
Country	:	US
Telephone Number	:	910-484-1722
Fax Number	:

Authorized Official
Title or Position	:	SVP OUTPATIENT PEDIATRICS
Name	:	TERRA RAE SCOTT
Credential	:
Telephone Number	:	303-437-4364

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	10/10/2023

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Directions to “AUTISM THERAPEUTIC SERVICES ” Practice Location

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