Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013221795 |
---|---|
Provider Name | Mrs. Marie Michelle Mcgrellis |
First Address | Frederica, DE 19946-2921 |
Second Address | Frederica, DE 19946-2921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 04/08/2010 |