Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-16-18583 |
NPI | 1003380742 |
---|---|
Provider Name | Amy Anderson |
First Address | Nashville, TN 37217-2679 |
Second Address | Warner Robins, GA 31093-2684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2019 |
Last Update Date | 16/01/2019 |