Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician |
NPI | 1003358292 |
---|---|
Provider Name | Pamela Tanner |
First Address | Ocoee, FL 34761-5038 |
Second Address | Ocoee, FL 34761-5038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2016 |
Last Update Date | 06/11/2016 |