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NPI Code Detail

MEDICARE: TRACIE YAMAUCHI RBT

MEDICARE: TRACIE YAMAUCHI 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 TechnicianBACB468961

General Provider Information

NPI Number : 1881166379
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACIE YAMAUCHI RBT
Provider Business Mailing Address
First Line : 3771 STEFANI RD
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-7795
Country : US
Telephone Number : 850-607-6910
Fax Number : 850-607-6932
Provider Business Practice Location Address
First Line : 5900 WARM SPRINGS RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-4362
Country : US
Telephone Number : 850-607-6910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2018
Last Update Date : 12/21/2018

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Directions to “ TRACIE YAMAUCHI RBT” Practice Location

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