| NPI | 1942604772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 172V00000X Community Health Worker | |
| 103K00000X Behavior Analyst | |
| 222Q00000X Developmental Therapist | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2016-03-31 |