Healthcare Provider Details

I. General information

NPI: 1144886581
Provider Name (Legal Business Name): REBECCA MARIE BOUDREAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA MARIE GRAEBER

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26844 TANIC DR
WESLEY CHAPEL FL
33544-4616
US

IV. Provider business mailing address

26844 TANIC DR
WESLEY CHAPEL FL
33544-4616
US

V. Phone/Fax

Practice location:
  • Phone: 813-710-3014
  • Fax: 813-710-3014
Mailing address:
  • Phone: 813-710-3014
  • Fax: 813-710-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: