Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003399023 |
---|---|
Provider Name | Karoline R Moreira |
First Address | Fort Myers, FL 33905-6832 |
Second Address | Fort Myers, FL 33905-6832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2018 |
Last Update Date | 14/09/2018 |