Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-129769 | FL |
NPI | 1003425620 |
---|---|
Provider Name | Brittany Lane |
First Address | Mary Esther, FL 32569-1990 |
Second Address | Mary Esther, FL 32569-1990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2020 |
Last Update Date | 29/07/2020 |