MEDICARE: SARA M BRECKENRIDGE

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-22-224931	KY

General Provider Information

NPI Number	:	1528782836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA M BRECKENRIDGE

Provider Business Mailing Address
First Line	:	3216 BALLARD LN
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-7200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9943 FOREST GREEN BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5123
Country	:	US
Telephone Number	:	502-830-9454
Fax Number	:

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

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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Directions to “ SARA M BRECKENRIDGE ” Practice Location

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