Most Relevant Information
Provider Data
| NPI Number: | 1003599903 |
| Provider Name: | MYRACLE AH-MIE BRODY |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/08/2023 |
| Last Updated: | 08/08/2023 |
Provider Practice Location
296 MERCHANTS SQ
DALLAS
GA
301325029
Practice Location Phone/Fax
| Phone: | 4703912300 |
| Fax: |
Provider Mailing Location
300 INTERNATIONAL PKWY STE 200
LAKE MARY
FL
327465028
Provider Mailing Phone/Fax
| Phone: | 8666100580 |
| Fax: |