MEDICARE: HANNAH WALLER 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
1	106S00000X	Behavior Technician	RBT1148	NV

General Provider Information

NPI Number	:	1205456449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH WALLER RBT

Provider Business Mailing Address
First Line	:	7212 REDHEAD DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2300
Country	:	US
Telephone Number	:	854-202-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 W ANN RD STE 120
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4407
Country	:	US
Telephone Number	:	702-323-6555
Fax Number	:

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

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	04/17/2020

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