MEDICARE: ETHAN WRIGHT

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	RBT-25-446890	MI

General Provider Information

NPI Number	:	1902751092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN WRIGHT

Provider Business Mailing Address
First Line	:	1288 BARNESWOOD LN
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48306-4114
Country	:	US
Telephone Number	:	402-369-9079
Fax Number	:

Provider Business Practice Location Address
First Line	:	1288 BARNESWOOD LN
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48306-4114
Country	:	US
Telephone Number	:	402-369-9079
Fax Number	:

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

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

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Directions to “ ETHAN WRIGHT ” Practice Location

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