MEDICARE: MS. ARIES JEWEL ELIZABETH JARVIS

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

General Provider Information

NPI Number	:	1407506116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARIES JEWEL ELIZABETH JARVIS

Provider Business Mailing Address
First Line	:	157 AGIN WAY
Second Line	:
City	:	MILTON
State	:	KY
Zip	:	40045-1510
Country	:	US
Telephone Number	:	812-599-7564
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 W JACKSON ST
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-1295
Country	:	US
Telephone Number	:	317-512-2101
Fax Number	:

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

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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