MEDICARE: MADISON CHRISTINA BREANA KNOWLES

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	:	1770431280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON CHRISTINA BREANA KNOWLES

Provider Business Mailing Address
First Line	:	4698 SE CONIFER PARK DR APT C203
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2149
Country	:	US
Telephone Number	:	360-509-3508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-443-2399
Fax Number	:	360-443-6121

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

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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