NPI | 1619633393 |
---|---|
Former Name | SHELBY MOAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: OK 353) |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: OK RBT-21-157074) |
Enumeration Date | 2021-11-16 |
Last Update Date | 2024-11-13 |