MEDICARE: RACHEL BROWN BCABA

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	0-10-3860	FL

General Provider Information

NPI Number	:	1154634277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL BROWN BCABA

Provider Business Mailing Address
First Line	:	15435 PLANTATION OAKS DR
Second Line	:	APT16
City	:	TAMPA
State	:	FL
Zip	:	33647-2131
Country	:	US
Telephone Number	:	813-374-2673
Fax Number	:

Provider Business Practice Location Address
First Line	:	15435 PLANTATION OAKS DR
Second Line	:	APT16
City	:	TAMPA
State	:	FL
Zip	:	33647-2131
Country	:	US
Telephone Number	:	813-374-2673
Fax Number	:

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

Provider Enumeration Date	:	07/18/2010
Last Update Date	:	07/18/2010

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