Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | RBT-21-19165 | FL |
NPI | 1003572611 |
---|---|
Provider Name | Rebekah Lynn Blackwell |
First Address | Mary Esther, FL 32569-1991 |
Second Address | Mary Esther, FL 32569-1991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2021 |
Last Update Date | 09/11/2021 |