Most Relevant Information
Provider Data
| NPI Number: | 1003371071 |
| Provider Name: | MASHA KOZHEVNIKOVA THERAPIST |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/04/2019 |
| Last Updated: | 02/04/2019 |
Provider Practice Location
901 O ST STE C
ARCATA
CA
955215789
Practice Location Phone/Fax
| Phone: | 7074979335 |
| Fax: |
Provider Mailing Location
390 UNION BLVD STE 300
LAKEWOOD
CO
802286514
Provider Mailing Phone/Fax
| Phone: | 3039898172 |
| Fax: |