MEDICARE: DEBRAH JANE WORLAND MA, BCBA

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	103K00000X	Behavior Analyst	1-11-9344	IN

General Provider Information

NPI Number	:	1619316973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRAH JANE WORLAND MA, BCBA

Provider Business Mailing Address
First Line	:	5523 GLEN CANYON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-4412
Country	:	US
Telephone Number	:	317-519-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	5523 GLEN CANYON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-4412
Country	:	US
Telephone Number	:	317-519-6692
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	03/27/2014

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