Most Relevant Information
Provider Data
| NPI Number: | 1003474339 |
| Provider Name: | HOLLY L BAYLESS DA COSTA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/02/2019 |
| Last Updated: | 06/02/2019 |
Provider Practice Location
3562 A ST
TACOMA
WA
984187902
Practice Location Phone/Fax
| Phone: | 2533764636 |
| Fax: |
Provider Mailing Location
3562 A ST
TACOMA
WA
984187902
Provider Mailing Phone/Fax
| Phone: | 2533764636 |
| Fax: |