=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114626546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL CAUDILLO RBT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2023
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 758 N SUN DR STE 112
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-2599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-317-5429
-----------------------------------------------------
Fax | 321-800-7201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1509 E COLONIAL DR STE 300
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-4729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-218-4340
-----------------------------------------------------
Fax | 321-800-7202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------