Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003417924 |
---|---|
Provider Name | Francine Bryan |
First Address | Lake Mary, FL 32746-5028 |
Second Address | Marietta, GA 30068-4948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2020 |
Last Update Date | 06/11/2020 |