MEDICARE: MS. GAIL DIANE PALECHKA MS BCBA LABA

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	103K00000X	Behavior Analyst	1104	MA

General Provider Information

NPI Number	:	1104333616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL DIANE PALECHKA MS BCBA LABA

Provider Business Mailing Address
First Line	:	129 N UNION ST
Second Line	:
City	:	PLAINFIELD
State	:	MA
Zip	:	01070-9604
Country	:	US
Telephone Number	:	269-598-4318
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 N UNION ST
Second Line	:
City	:	PLAINFIELD
State	:	MA
Zip	:	01070-9604
Country	:	US
Telephone Number	:	269-598-4318
Fax Number	:

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

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	01/05/2018

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