MEDICARE: MRS. PAIGE HAILS 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	247200000X	Other Technician	RBT--16-26303	FL

General Provider Information

NPI Number	:	1598200305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAIGE HAILS RBT

Provider Business Mailing Address
First Line	:	PO BOX 19212
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33416-9212
Country	:	US
Telephone Number	:	561-541-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	6212 FOREST HILL BLVD
Second Line	:	105
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-6145
Country	:	US
Telephone Number	:	561-541-6023
Fax Number	:

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

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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