Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003418633 |
---|---|
Provider Name | Ms. Taylor Bradshaw |
First Address | Cordova, TN 38018-0115 |
Second Address | Memphis, TN 38152-3920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2020 |
Last Update Date | 09/11/2020 |