Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003424672 |
---|---|
Provider Name | Anysa Lewis |
First Address | Lake Mary, FL 32746-5028 |
Second Address | Tampa, FL 33626-1314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2020 |
Last Update Date | 20/07/2020 |