Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 111617000 | FL |
NPI | 1144973835 |
---|---|
Provider Name | Tiana Marie Brady |
First Address | Vero Beach, FL 32960-4011 |
Second Address | Vero Beach, FL 32960-4011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111617000 | (05) | FL |