Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | BACB380802 | SC |
NPI | 1003398280 |
---|---|
Provider Name | Mrs. Kelsey Meredith Oates |
First Address | Charleston, SC 29407-4194 |
Second Address | Walterboro, SC 29488-7770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |