Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-17-35933 | FL |
NPI | 1003336462 |
---|---|
Provider Name | Mrs. Elizabeth Irene Hart |
First Address | Fort Walton Beach, FL 32548-6307 |
Second Address | Fort Walton Beach, FL 32548-5425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 26/06/2017 |