MEDICARE: MRS. SABRINA RACHELLE IRELAND

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
1	103K00000X	Behavior Analyst	1-26-89734	KY
2	106S00000X	Behavior Technician	RBT-18-59994	KY

General Provider Information

NPI Number	:	1144888777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SABRINA RACHELLE IRELAND

Provider Business Mailing Address
First Line	:	103 WINDSOR PATH STE 2
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9610
Country	:	US
Telephone Number	:	859-757-1022
Fax Number	:	901-545-5189

Provider Business Practice Location Address
First Line	:	103 WINDSOR PATH STE 2
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9610
Country	:	US
Telephone Number	:	859-757-1022
Fax Number	:	901-545-5189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/05/2026

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