Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003267238 |
---|---|
Provider Name | Kayla Matthews |
First Address | Pocasset, MA 02559-1980 |
Second Address | Pocasset, MA 02559-1980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 29/06/2016 |