MEDICARE: MRS. REBE NICOLE ARRIETA RBT

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	RBT-16-21092	FL

General Provider Information

NPI Number	:	1316482706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBE NICOLE ARRIETA RBT

Provider Business Mailing Address
First Line	:	4779 BALBOA RD
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-6349
Country	:	US
Telephone Number	:	847-912-9708
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 STATE HIGHWAY 83 UNIT A101
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-7427
Country	:	US
Telephone Number	:	850-585-9189
Fax Number	:	850-951-0898

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

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	12/21/2016

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