=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295160356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHAEL E RUDLOFF M.S., BCBA, LABA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2013
-----------------------------------------------------
Last Update Date | 01/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 TEAKWOOD DR W
-----------------------------------------------------
City | COVENTRY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02816-8585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-595-3773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 TEAKWOOD DR W
-----------------------------------------------------
City | COVENTRY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02816-8585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-595-3773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------