Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-51630 |
NPI | 1003379033 |
---|---|
Provider Name | Megan Kleitz |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Louisville, KY 40229-2183 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2019 |
Last Update Date | 08/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RBT-18-51630 | RBT CERTIFICATE (01) |