Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-148388 | OH |
NPI | 1003402827 |
---|---|
Provider Name | Casey Surblis |
First Address | Westlake, OH 44145-3902 |
Second Address | Westlake, OH 44145-3902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2020 |
Last Update Date | 16/12/2020 |