Healthcare Provider Details

I. General information

NPI: 1497486914
Provider Name (Legal Business Name): RACHAEL ANNE CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W NASA BLVD UNIT C-1
MELBOURNE FL
32901-2614
US

IV. Provider business mailing address

1365 NIMITZ CT
ROCKLEDGE FL
32955-5151
US

V. Phone/Fax

Practice location:
  • Phone: 153-513-2901
  • Fax:
Mailing address:
  • Phone: 321-423-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: