MEDICARE: WILLIAM JOHN MCINTYRE

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	:	1457177636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOHN MCINTYRE

Provider Business Mailing Address
First Line	:	10510 JOOR RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3900
Country	:	US
Telephone Number	:	225-960-2403
Fax Number	:	225-256-1707

Provider Business Practice Location Address
First Line	:	10510 JOOR RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3900
Country	:	US
Telephone Number	:	225-960-2403
Fax Number	:	225-256-1707

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

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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