MEDICARE: TASCHA SUTTON 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	RBT-19-82788	OH

General Provider Information

NPI Number	:	1255893970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASCHA SUTTON RBT

Provider Business Mailing Address
First Line	:	3046 KENSINGTON RD APT 3
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-3576
Country	:	US
Telephone Number	:	440-384-9934
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 WRENFORD RD
Second Line	:
City	:	UNIVERSITY HTS
State	:	OH
Zip	:	44118-3902
Country	:	US
Telephone Number	:	440-384-9934
Fax Number	:

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/02/2019

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Directions to “ TASCHA SUTTON RBT” Practice Location

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