MEDICARE: WILLIAM MABREY JR.

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1730637687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MABREY JR.

Provider Business Mailing Address
First Line	:	201 THORNBERRY BRANCH LN
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-3652
Country	:	US
Telephone Number	:	513-332-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	1042 THUNDERBIRD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5824
Country	:	US
Telephone Number	:	513-332-8253
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/14/2017

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Directions to “ WILLIAM MABREY JR. ” Practice Location

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