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1821726704
JOHNTAVIA WALLACE
BRANDON, FL
NPI
1821726704
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-08-10
Last Update Date
2022-08-10
Business Address
JOHNTAVIA WALLACE
220 GRAND REGENCY BLVD
BRANDON, FL 33510-3935
Phone number: 813-709-7989
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Mailing Address
JOHNTAVIA WALLACE
3500 DEPAUW BLVD STE 3070
INDIANAPOLIS, IN 46268-6135
Phone number: 855-324-0885
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