MEDICARE: ABIGAILO CHANDLER BEGLEY HS ; 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-18-57397

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-18-57397	OTHER		RBT CERTIFICATE

General Provider Information

NPI Number	:	1508419128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAILO CHANDLER BEGLEY HS ; RBT

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	317-516-6489
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 STATE ROUTE 28
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-5021
Country	:	US
Telephone Number	:	513-831-2578
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “ ABIGAILO CHANDLER BEGLEY HS ; RBT” Practice Location

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