MEDICARE: RACHEL JOY MANUEL BCBA

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	0-12-5035	GA

General Provider Information

NPI Number	:	1962767129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL JOY MANUEL BCBA

Provider Business Mailing Address
First Line	:	6 SAINT LO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-1705
Country	:	US
Telephone Number	:	254-702-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 17TH ST STE 11
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	706-780-1704
Fax Number	:	706-780-1705

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

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	10/08/2024

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