Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003410333 |
---|---|
Provider Name | Kayla Micheau |
First Address | Hopkins, MI 49328-9748 |
Second Address | Wyoming, MI 49509-9506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2020 |
Last Update Date | 27/11/2020 |