| NPI | 1154895274 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 106S00000X Behavior Technician (Licence: FL 18-69538) | |
| 106S00000X Behavior Technician (Licence: FL RBT-18-69538) | |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2022-10-12 |