Most Relevant Information
Provider Data
| NPI Number: | 1003682261 |
| Provider Name: | MATTHEW MYLES TELEMAQUE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/29/2023 |
| Last Updated: | 11/29/2023 |
Provider Practice Location
4552 SPAHR ST
HOLT
MI
488421122
Practice Location Phone/Fax
| Phone: | 5179309381 |
| Fax: |
Provider Mailing Location
4552 SPAHR ST
HOLT
MI
488421122
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |