Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003406281 |
---|---|
Provider Name | Ofelia Velazquez Chavez |
First Address | Coeur D Alene, ID 83814-0012 |
Second Address | Gig Harbor, WA 98332-6867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2021 |
Last Update Date | 21/01/2021 |