Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 18-49334 | GA |
NPI | 1003318643 |
---|---|
Provider Name | Rodricka Foreman |
First Address | Bowling Green, KY 42104-3250 |
Second Address | Byron, GA 31008-6646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 28/02/2018 |