Most Relevant Information
Provider Data
| NPI Number: | 1003357088 |
| Provider Name: | THERESA ROSE BLOSS |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/10/2017 |
| Last Updated: | 03/10/2017 |
Provider Practice Location
1363 DOUGLAS DR
SUITE 104
TRAVERSE CITY
MI
496968980
Practice Location Phone/Fax
| Phone: | 2316684909 |
| Fax: |
Provider Mailing Location
1363 DOUGLAS DR
SUITE 104
TRAVERSE CITY
MI
496968980
Provider Mailing Phone/Fax
| Phone: | 2316684909 |
| Fax: |