MEDICARE: TARA JO GOHEEN 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
1	106S00000X	Behavior Technician	RBT-24-391471	FL

General Provider Information

NPI Number	:	1013731850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA JO GOHEEN RBT

Provider Business Mailing Address
First Line	:	1982 SE BURGUNDY LN
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-8866
Country	:	US
Telephone Number	:	417-392-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 SW CORPORATE PKWY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8154
Country	:	US
Telephone Number	:	772-222-5560
Fax Number	:	844-652-8088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	04/07/2026

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Directions to “ TARA JO GOHEEN RBT” Practice Location

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