Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003418211 |
---|---|
Provider Name | Kailyn Manuel |
First Address | Fairborn, OH 45324-6333 |
Second Address | Fairborn, OH 45324-6333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2020 |
Last Update Date | 12/11/2020 |