MEDICARE: MISTICAL RAE VAUGHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	172A00000X	Driver
2	3747P1801X	Personal Care Attendant
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1801549365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTICAL RAE VAUGHN

Provider Business Mailing Address
First Line	:	254 COUNTY HIGHWAY 35
Second Line	:
City	:	MC CUTCHENVILLE
State	:	OH
Zip	:	44844-9719
Country	:	US
Telephone Number	:	419-835-2389
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 COUNTY HIGHWAY 35
Second Line	:
City	:	MC CUTCHENVILLE
State	:	OH
Zip	:	44844-9719
Country	:	US
Telephone Number	:	419-835-2389
Fax Number	:

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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Directions to “ MISTICAL RAE VAUGHN ” Practice Location

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