Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-70698 | FL |
NPI | 1003370420 |
---|---|
Provider Name | Schylar Michael Weirich |
First Address | Fruitland Park, FL 34731-5617 |
Second Address | Fruitland Park, FL 34731-5617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2019 |
Last Update Date | 30/01/2019 |