MEDICARE: MRS. MEGAN CLEMENTINE BAUSCH M.S., BCBA

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	1-09-6042	FL

General Provider Information

NPI Number	:	1164753398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN CLEMENTINE BAUSCH M.S., BCBA

Provider Business Mailing Address
First Line	:	36468 EMERALD COAST PKWY
Second Line	:	SUITE 2101
City	:	DESTIN
State	:	FL
Zip	:	32541-4799
Country	:	US
Telephone Number	:	850-837-1200
Fax Number	:	850-269-2341

Provider Business Practice Location Address
First Line	:	36468 EMERALD COAST PKWY
Second Line	:	SUITE 2101
City	:	DESTIN
State	:	FL
Zip	:	32541-4799
Country	:	US
Telephone Number	:	850-837-1200
Fax Number	:	850-269-2341

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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