Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003374224 |
---|---|
Provider Name | Kora Santiago Puddin' |
First Address | Kirkland, WA 98033-5779 |
Second Address | Kirkland, WA 98033-5779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 06/03/2019 |