MEDICARE: ASHLEY ABBOTT

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

General Provider Information

NPI Number	:	1912384884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ABBOTT

Provider Business Mailing Address
First Line	:	3815 BRECKINRIDGE LN
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-9003
Country	:	US
Telephone Number	:	352-223-1999
Fax Number	:	352-600-3119

Provider Business Practice Location Address
First Line	:	409 E OAKLAND AVE
Second Line	:	SUITE B
City	:	OAKLAND
State	:	FL
Zip	:	34787-3070
Country	:	US
Telephone Number	:	352-223-1999
Fax Number	:	352-600-3119

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

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	04/30/2015

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