MEDICARE: TABITHA RAINS

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	RBT-21-194282	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245982503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA RAINS

Provider Business Mailing Address
First Line	:	PO BOX 631278
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-1278
Country	:	US
Telephone Number	:	800-356-4049
Fax Number	:	941-485-0519

Provider Business Practice Location Address
First Line	:	6196 LAKE GRAY BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-7503
Country	:	US
Telephone Number	:	800-356-4049
Fax Number	:	941-485-0519

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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Directions to “ TABITHA RAINS ” Practice Location

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