Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003415043 |
---|---|
Provider Name | Madison Katherine Rose Markham |
First Address | Overland Park, KS 66211-1506 |
Second Address | Overland Park, KS 66211-1506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |