Most Relevant Information
Provider Data
| NPI Number: | 1003589524 |
| Provider Name: | LA TISHA AZANA BUTCHER |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/29/2021 |
| Last Updated: | 10/14/2022 |
Provider Practice Location
2930 MAGUIRE RD STE 200
OCOEE
FL
347614750
Practice Location Phone/Fax
| Phone: | 4075025010 |
| Fax: |
Provider Mailing Location
175 MIDDLE ST UNIT 1201
LAKE MARY
FL
327463625
Provider Mailing Phone/Fax
| Phone: | 8666100580 |
| Fax: |