MEDICARE: AUTUMN RAIN FOX

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		OH

General Provider Information

NPI Number	:	1750242285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN RAIN FOX

Provider Business Mailing Address
First Line	:	4254 STATE ROUTE 61 S
Second Line	:
City	:	SHELBY
State	:	OH
Zip	:	44875-8922
Country	:	US
Telephone Number	:	419-747-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	4254 STATE ROUTE 61 S
Second Line	:
City	:	SHELBY
State	:	OH
Zip	:	44875-8922
Country	:	US
Telephone Number	:	419-747-4122
Fax Number	:

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

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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Directions to “ AUTUMN RAIN FOX ” Practice Location

Language	Start Address	Practice Location

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