Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1154869907 |
---|---|
Provider Name | Mickaylaa S Kimball |
First Address | Labelle, FL 33935-5347 |
Second Address | Labelle, FL 33935-5347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2017 |
Last Update Date | 01/02/2017 |