Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1003570672 |
---|---|
Provider Name | Amanda Theresa Watson |
First Address | Stuart, FL 34997-7462 |
Second Address | Groveland, CA 95321-9540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2021 |
Last Update Date | 28/10/2021 |