Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1164048229 |
---|---|
Provider Name | Jacob Keaton |
First Address | Lewisburg, WV 24901-5629 |
Second Address | Lewisburg, WV 24901-0010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2020 |
Last Update Date | 24/06/2020 |