MEDICARE: BRIANA N LEE 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-19-107339	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-19-107339	OTHER	KY	RBT

General Provider Information

NPI Number	:	1053046680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA N LEE RBT

Provider Business Mailing Address
First Line	:	3216 BALLARD LN
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-7200
Country	:	US
Telephone Number	:	812-590-2157
Fax Number	:	866-680-4566

Provider Business Practice Location Address
First Line	:	9943 FOREST GREEN BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5123
Country	:	US
Telephone Number	:	502-830-9454
Fax Number	:

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

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	07/18/2022

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Directions to “ BRIANA N LEE RBT” Practice Location

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