Most Relevant Information
Provider Data
| NPI Number: | 1003459314 |
| Provider Name: | KEVIN JOHN |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/21/2019 |
| Last Updated: | 10/21/2019 |
Provider Practice Location
69068 BEEBE ST APT 86
RICHMOND
MI
480621511
Practice Location Phone/Fax
| Phone: | 8105992129 |
| Fax: |
Provider Mailing Location
PO BOX 663
LAKELAND
MI
481430663
Provider Mailing Phone/Fax
| Phone: | 8105592129 |
| Fax: |