MEDICARE: MADELYN GRACE HUNT 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

General Provider Information

NPI Number	:	1053206839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN GRACE HUNT RBT

Provider Business Mailing Address
First Line	:	5370 JOE BROWN HWY S
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-8922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3030
Country	:	US
Telephone Number	:	813-763-5469
Fax Number	:	813-441-8362

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

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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