| NPI | 1174967350 |
|---|---|
| Former Name | THERESA AILEEN BROOKING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MO 11211754) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: MO 11211754) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-04-18 |