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NPI Code Detail

MEDICARE: RASHAE PETERSON

MEDICARE: RASHAE PETERSON
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 : 1528750023
Entity Type Code : Individual
Provider Name (Legal Business Name) : RASHAE PETERSON
Provider Business Mailing Address
First Line : 906 SEMINOLE DR
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7648
Country : US
Telephone Number : 772-475-5313
Fax Number :
Provider Business Practice Location Address
First Line : 906 SEMINOLE DR
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7648
Country : US
Telephone Number : 772-475-5313
Fax Number : 800-374-4167
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2023
Last Update Date : 05/23/2023

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Directions to “ RASHAE PETERSON ” Practice Location

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