Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003381328 |
---|---|
Provider Name | Kaili Ann Preston |
First Address | Berlin, MD 21811-3241 |
Second Address | Berlin, MD 21811-3241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2018 |
Last Update Date | 12/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
483106300 | (05) | MD |