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NPI Code Detail

MEDICARE: AUTUMN EISENHUTH

MEDICARE: AUTUMN EISENHUTH
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
1106S00000XBehavior TechnicianRBT-24-330130AZ

General Provider Information

NPI Number : 1427904945
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN EISENHUTH
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 5701 W TALAVI BLVD
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-1886
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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Directions to “ AUTUMN EISENHUTH ” Practice Location

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