Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373853 |
---|---|
Provider Name | Tara Brachtenbach |
First Address | Overland Park, KS 66204 |
Second Address | Kansas City, MO 64108-2110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 28/02/2019 |