Most Relevant Information
Provider Data
| NPI Number: | 1003389826 |
| Provider Name: | KATINA BLAINE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/03/2019 |
| Last Updated: | 02/20/2019 |
Provider Practice Location
5501 ANTIQUE ROSE WAY
RIVERBANK
CA
95367
Practice Location Phone/Fax
| Phone: | 2095214791 |
| Fax: |
Provider Mailing Location
3425 COFFEE RD STE C2
MODESTO
CA
953551582
Provider Mailing Phone/Fax
| Phone: | 2095214791 |
| Fax: |