Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-2-49264 | VT |
N | 103K00000X | Behavior Analyst | 146.134212 | VT |
NPI | 1003484080 |
---|---|
Provider Name | Thomas Heisler |
First Address | Springfield, VT 05156-2226 |
Second Address | Brattleboro, VT 05301-6629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 22/06/2021 |