Most Relevant Information
Provider Data
| NPI Number: | 1003676487 |
| Provider Name: | FANTASIA MORE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/21/2024 |
| Last Updated: | 03/21/2024 |
Provider Practice Location
3111 124TH AVE NW STE 150
COON RAPIDS
MN
554334581
Practice Location Phone/Fax
| Phone: | 7632725877 |
| Fax: |
Provider Mailing Location
3111 124TH AVE NW STE 150
COON RAPIDS
MN
554334581
Provider Mailing Phone/Fax
| Phone: | 7632725877 |
| Fax: |