Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0-21-54658 | FL |
N | 106E00000X | Assistant Behavior Analyst | 0-17-8157 | FL |
NPI | 1093193021 |
---|---|
Provider Name | Kaylavictoria Obamwonyi |
First Address | Stuart, FL 34997-7462 |
Second Address | Jacksonville, FL 32258-9486 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100149700 | (05) | FL |