MEDICARE: SARAH SAORI REYNOLDS BCABA

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	103K00000X	Behavior Analyst	0-11-4173

General Provider Information

NPI Number	:	1861770372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SAORI REYNOLDS BCABA

Provider Business Mailing Address
First Line	:	1602 WILLIAM ST UPPR FL
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5549
Country	:	US
Telephone Number	:	540-368-8087
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 WILLIAM ST UPPR FL
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5549
Country	:	US
Telephone Number	:	540-368-8087
Fax Number	:

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

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	08/01/2011

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