MEDICARE: HANNAH ELIZABETH TETREAULT

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	:	1063113157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH ELIZABETH TETREAULT

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 JEFFERSON ST
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-2937
Country	:	US
Telephone Number	:	774-331-1964
Fax Number	:

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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