MEDICARE: MRS. RACHEL KELLY PERKINS 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	RBT-19-84528	UT
2	2255A2300X	Athletic Trainer
3	2255A2300X	Athletic Trainer		UT

General Provider Information

NPI Number	:	1912560368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL KELLY PERKINS RBT

Provider Business Mailing Address
First Line	:	1443 W 800 N STE 103
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84057-2878
Country	:	US
Telephone Number	:	801-655-4950
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 S 250 W APT 2
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-6466
Country	:	US
Telephone Number	:	435-632-6904
Fax Number	:

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

Provider Enumeration Date	:	04/20/2019
Last Update Date	:	05/05/2023

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