Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 17890081331 |
NPI | 1003324203 |
---|---|
Provider Name | Kaytlin Marie Smith |
First Address | Anchorage, AK 99508-5329 |
Second Address | Anchorage, AK 99508-5329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2018 |
Last Update Date | 22/01/2018 |