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NPI Code Detail

MEDICARE: ALLYSON RAY RBT

MEDICARE: ALLYSON RAY 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 Technician

General Provider Information

NPI Number : 1770287575
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLYSON RAY RBT
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number : 574-387-4313
Fax Number :
Provider Business Practice Location Address
First Line : 8413 COTTONWOOD DR
Second Line :
City : JENISON
State : MI
Zip : 49428-8327
Country : US
Telephone Number : 574-387-4313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2023
Last Update Date : 03/28/2023

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Directions to “ ALLYSON RAY RBT” Practice Location

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