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NPI Code Detail

MEDICARE: ROSE PATE

MEDICARE: ROSE PATE
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 Technician17-33541SC
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1245733625
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSE PATE
Provider Business Mailing Address
First Line : 181 W PROFESSIONAL PARK CT STE 1
Second Line :
City : BOWLING GREEN
State : KY
Zip : 42104-3250
Country : US
Telephone Number : 270-777-9283
Fax Number : 270-777-9283
Provider Business Practice Location Address
First Line : 1345 COMPANION CT
Second Line :
City : SUMTER
State : SC
Zip : 29150-1749
Country : US
Telephone Number : 803-905-5107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2018
Last Update Date : 03/16/2020

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Directions to “ ROSE PATE ” Practice Location

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