Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003408295 |
---|---|
Provider Name | Kari Antczak |
First Address | Austin, TX 78759-6387 |
Second Address | Austin, TX 78759-6387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 09/02/2021 |