Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-17-31845 | TX |
NPI | 1003310962 |
---|---|
Provider Name | Kaitlyn Mouro Traster |
First Address | Keller, TX 76248-8488 |
Second Address | Keller, TX 76248-8488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2018 |
Last Update Date | 23/03/2018 |