MEDICARE: ABBEY MICHELE MILLS 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	103K00000X	Behavior Analyst	RBT-18-60286	MO
2	106S00000X	Behavior Technician	RBT-18-60286	MO
3	103K00000X	Behavior Analyst	1-23-63968

General Provider Information

NPI Number	:	1396379574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBEY MICHELE MILLS RBT

Provider Business Mailing Address
First Line	:	4721 S CLIFF AVE STE 103
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6969
Country	:	US
Telephone Number	:	816-608-1958
Fax Number	:	800-687-5070

Provider Business Practice Location Address
First Line	:	96 GRASSO PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-3108
Country	:	US
Telephone Number	:	816-608-1500
Fax Number	:	800-687-5070

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	02/24/2023

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