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NPI Code Detail

MEDICARE: TMARYAE BRAZELTON RBT

MEDICARE: TMARYAE BRAZELTON 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1477366730
Entity Type Code : Individual
Provider Name (Legal Business Name) : TMARYAE BRAZELTON RBT
Provider Business Mailing Address
First Line : 1930 PICADILLY PL
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-5006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4410 EXECUTIVE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46808-1135
Country : US
Telephone Number : 888-515-1793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2025
Last Update Date : 01/30/2025

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Directions to “ TMARYAE BRAZELTON RBT” Practice Location

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