MEDICARE: RACHEL MCDONOUGH

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

General Provider Information

NPI Number	:	1417563826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MCDONOUGH

Provider Business Mailing Address
First Line	:	537 DELTONA BLVD
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-8017
Country	:	US
Telephone Number	:	904-878-8683
Fax Number	:	386-200-5752

Provider Business Practice Location Address
First Line	:	583 TREEHOUSE ST
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6507
Country	:	US
Telephone Number	:	904-878-8683
Fax Number	:	386-200-5752

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

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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Directions to “ RACHEL MCDONOUGH ” Practice Location

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