Most Relevant Information
Provider Data
| NPI Number: | 1003379447 |
| Provider Name: | MAKAYLA SAMPLE |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/11/2019 |
| Last Updated: | 04/11/2019 |
Provider Practice Location
8282 28TH CT NE STE A
LACEY
WA
985167162
Practice Location Phone/Fax
| Phone: | 2537320385 |
| Fax: |
Provider Mailing Location
8282 28TH CT NE STE A
LACEY
WA
985167162
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |