Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | FL |
NPI | 1003232745 |
---|---|
Provider Name | Alyssa Heyer |
First Address | Melbourne, FL 32904-1093 |
Second Address | Melbourne, FL 32904-1093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2014 |
Last Update Date | 06/11/2018 |