MEDICARE: TATTIANA BAILEY-WALTERS

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

General Provider Information

NPI Number	:	1669067468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATTIANA BAILEY-WALTERS

Provider Business Mailing Address
First Line	:	1012 CANNON VIEW LN APT 4
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-4866
Country	:	US
Telephone Number	:	929-336-8742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 CANNON VIEW LN APT 4
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-4866
Country	:	US
Telephone Number	:	929-336-8742
Fax Number	:

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

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	03/03/2021

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