MEDICARE: MRS. ERIN ALEXANDER AUDETTE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699252486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN ALEXANDER AUDETTE

Provider Business Mailing Address
First Line	:	1034 MITSCHER DR
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-7020
Country	:	US
Telephone Number	:	586-703-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 COLLEGE RD
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-4315
Country	:	US
Telephone Number	:	586-703-0556
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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