| NPI | 1396383568 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | MONICA HAMMEL Credentialing Manager 765-461-5410  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 103K00000X Behavior Analyst | 
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, | 
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2019-12-18 | 
| Last Update Date | 2021-12-14 |