MEDICARE: RACHEL LYNN MIDDLETON

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	174H00000X	Health Educator
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518333194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LYNN MIDDLETON

Provider Business Mailing Address
First Line	:	4801 S UNIVERSITY DR STE 3100
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-3844
Country	:	US
Telephone Number	:	954-270-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 S UNIVERSITY DR STE 3100
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-3844
Country	:	US
Telephone Number	:	954-270-5322
Fax Number	:

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

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	01/22/2021

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