MEDICARE: MRS. RACHAEL MAE DENMON

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	:	1952976680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHAEL MAE DENMON

Provider Business Mailing Address
First Line	:	1081 OAK ST
Second Line	:
City	:	INKERMAN
State	:	PA
Zip	:	18640-3716
Country	:	US
Telephone Number	:	570-802-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 OAK ST
Second Line	:
City	:	INKERMAN
State	:	PA
Zip	:	18640-3716
Country	:	US
Telephone Number	:	570-802-3099
Fax Number	:

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/26/2021

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