MEDICARE: ALLYSSA LYNN TRIMBLE 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	106S00000X	Behavior Technician	RBT-19-93051	GA

General Provider Information

NPI Number	:	1629681317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSSA LYNN TRIMBLE RBT

Provider Business Mailing Address
First Line	:	3736 EXECUTIVE CENTER DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-2360
Country	:	US
Telephone Number	:	706-842-5330
Fax Number	:	706-842-5340

Provider Business Practice Location Address
First Line	:	3 JOHNSTON ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-5502
Country	:	US
Telephone Number	:	706-842-5330
Fax Number	:	706-842-5340

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	05/12/2021

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