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NPI Code Detail

MEDICARE: SARAH PENCILLE

MEDICARE:   SARAH  PENCILLE
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
1222Q00000XDevelopmental Therapist
2106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386039493
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH PENCILLE
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 : 407-915-7729
Fax Number :
Provider Business Practice Location Address
First Line : 306 WYNN DR NW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35805-1961
Country : US
Telephone Number : 256-882-2457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2015
Last Update Date : 08/25/2020

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Directions to “ SARAH PENCILLE ” Practice Location

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