Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | RBT-18-47176 | FL |
NPI | 1174031330 |
---|---|
Provider Name | Carolyn Wigmore |
First Address | Kissimmee, FL 34759-4706 |
Second Address | Kissimmee, FL 34759-4706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2018 |
Last Update Date | 22/01/2018 |