Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003262775 |
---|---|
Provider Name | Barbara Park |
First Address | Fort Myers, FL 33919-7204 |
Second Address | Fort Myers, FL 33919-7204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2016 |
Last Update Date | 11/05/2016 |