MEDICARE: RYAN OWENS

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	104100000X	Social Worker	7126	FL
2	103K00000X	Behavior Analyst

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	:	1801290689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN OWENS

Provider Business Mailing Address
First Line	:	1312 GUILPEN ST. NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907
Country	:	US
Telephone Number	:	321-961-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 CULVER DR NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1104
Country	:	US
Telephone Number	:	321-610-3849
Fax Number	:

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

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	06/23/2016

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