Most Relevant Information
Provider Data
| NPI Number: | 1003432493 |
| Provider Name: | MAYA MARIE JACOB |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/22/2020 |
| Last Updated: | 06/22/2020 |
Provider Practice Location
1360 PORTER ST
DEARBORN
MI
481242890
Practice Location Phone/Fax
| Phone: | 3136895188 |
| Fax: |
Provider Mailing Location
1360 PORTER ST
DEARBORN
MI
481242890
Provider Mailing Phone/Fax
| Phone: | 3136895188 |
| Fax: |