| NPI | 1558848804 |
|---|---|
| Former Name | BRADLY PAYTON SCOTT WALLING |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT61316314) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2022-07-07 |