Provider Demographics
NPI:1376020834
Name:THOMAS, RACHEL RUTHANN (RBT)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:RUTHANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E UNIVERSITY BLVD APT 11
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7173
Mailing Address - Country:US
Mailing Address - Phone:347-481-0020
Mailing Address - Fax:
Practice Address - Street 1:453 KING ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7621
Practice Address - Country:US
Practice Address - Phone:321-633-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-43077106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021403200Medicaid