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1205571130
MYA ANTONETTE WATSON-BLAKE
O FALLON, IL
NPI
1205571130
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-05-04
Last Update Date
2022-05-04
Business Address
MYA ANTONETTE WATSON-BLAKE RBT
145 SPRINGFIELD CT
O FALLON, IL 62269-2495
Phone number: 217-525-8332
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Mailing Address
MYA ANTONETTE WATSON-BLAKE RBT
5220 6TH STREET FRONTAGE RD E STE 1700
SPRINGFIELD, IL 62703-5771
Phone number: 217-525-8332
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