Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1063095206 |
---|---|
Provider Name | Tatyana Wilson |
First Address | Tamarac, FL 33309-2649 |
Second Address | Coral Springs, FL 33065-4162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2021 |
Last Update Date | 05/05/2021 |