MEDICARE: ASHLEY CASON

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	222Q00000X	Developmental Therapist
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790334498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY CASON

Provider Business Mailing Address
First Line	:	1408 NW 6TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32601-4020
Country	:	US
Telephone Number	:	352-373-4411
Fax Number	:	352-373-4455

Provider Business Practice Location Address
First Line	:	260 S. MARION AVENUE
Second Line	:	BUILDING A, SUITE 135
City	:	LAKE CITY
State	:	FL
Zip	:	32025-3202
Country	:	US
Telephone Number	:	352-373-4411
Fax Number	:	352-373-4455

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

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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Directions to “ ASHLEY CASON ” Practice Location

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