MEDICARE: AUDREY ELAINE HAMM 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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1841882024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY ELAINE HAMM RBT

Provider Business Mailing Address
First Line	:	8916 CAIRN RIDGE DR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-6666
Country	:	US
Telephone Number	:	901-517-7404
Fax Number	:

Provider Business Practice Location Address
First Line	:	8066 WALNUT RUN RD STE 102
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-8842
Country	:	US
Telephone Number	:	901-410-3595
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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