Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner |
NPI | 1285198705 |
---|---|
Provider Name | Anthony Tye Treece |
First Address | Stockton, CA 95202-1552 |
Second Address | Stockton, CA 95202-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2019 |
Last Update Date | 29/01/2019 |