MEDICARE: RACHEL MAE GRUE

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		GA
2	222Q00000X	Developmental Therapist
3	103K00000X	Behavior Analyst	11520047	GA

General Provider Information

NPI Number	:	1174992234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MAE GRUE

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 CADUCEUS WAY STE 101
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-7300
Country	:	US
Telephone Number	:	762-499-3476
Fax Number	:

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

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	01/13/2026

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Directions to “ RACHEL MAE GRUE ” Practice Location

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