Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-19-107708 | TX |
NPI | 1003409467 |
---|---|
Provider Name | Kayla Spence |
First Address | Spring, TX 77388 |
Second Address | Kingwood, TX 77339-2294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2021 |
Last Update Date | 17/02/2021 |