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NPI Code Detail

MEDICARE: SHANEECE MCCRARY RBT

MEDICARE: SHANEECE MCCRARY 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
1106S00000XBehavior TechnicianRBT-19-93945IN

General Provider Information

NPI Number : 1700552643
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANEECE MCCRARY RBT
Provider Business Mailing Address
First Line : 1824 TOUBY PIKE STE B
Second Line :
City : KOKOMO
State : IN
Zip : 46901-2573
Country : US
Telephone Number : 765-628-7400
Fax Number :
Provider Business Practice Location Address
First Line : 7507 MICHIGAN RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-2321
Country : US
Telephone Number : 317-769-2220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2021
Last Update Date : 08/20/2021

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