MEDICARE: MR. KURT J GARCIA

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

General Provider Information

NPI Number	:	1275839284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KURT J GARCIA

Provider Business Mailing Address
First Line	:	112 S CHICAGO AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61104-2468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 S CHICAGO AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61104-2468
Country	:	US
Telephone Number	:	708-990-9873
Fax Number	:

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

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	02/09/2011

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