MEDICARE: KAELA MICHELLE RAPER BCBA

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	:	1508477647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAELA MICHELLE RAPER BCBA

Provider Business Mailing Address
First Line	:	1631 SIMMONS RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8945
Country	:	US
Telephone Number	:	904-228-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 SIMMONS RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8945
Country	:	US
Telephone Number	:	904-228-0036
Fax Number	:

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

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	08/12/2020

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