Healthcare Provider Details

I. General information

NPI: 1043869928
Provider Name (Legal Business Name): RACHEL GRAMKE-BOOTH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 COLLEGE BLVD E
NICEVILLE FL
32578-1343
US

IV. Provider business mailing address

1923 RIDGE RD
HENDERSONVILLE NC
28792-7699
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-3000
  • Fax: 850-389-2269
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB392785
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: