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NPI Code Detail

MEDICARE: BAILEY SHANNON MUDD RBT

MEDICARE: BAILEY SHANNON MUDD RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT24335571IN

General Provider Information

NPI Number : 1003616350
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAILEY SHANNON MUDD RBT
Provider Business Mailing Address
First Line : 8350 CRAIG ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-3593
Country : US
Telephone Number : 317-578-0410
Fax Number :
Provider Business Practice Location Address
First Line : 8350 CRAIG ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-3593
Country : US
Telephone Number : 317-578-0410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2025
Last Update Date : 02/16/2026

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Directions to “ BAILEY SHANNON MUDD RBT” Practice Location

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