Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003325242 |
---|---|
Provider Name | Melissa Grewell |
First Address | Tampa, FL 33618-4426 |
Second Address | Tampa, FL 33618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2017 |
Last Update Date | 14/08/2018 |