Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-142714 | IN |
NPI | 1003412487 |
---|---|
Provider Name | Tayler Williams |
First Address | Indianapolis, IN 46268-6135 |
Second Address | South Bend, IN 46635-1512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2020 |
Last Update Date | 10/12/2020 |