Most Relevant Information
Provider Data
| NPI Number: | 1003696832 |
| Provider Name: | RAVEN BOATWRIGHT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/29/2023 |
| Last Updated: | 09/29/2023 |
Provider Practice Location
1220 E JOPPA RD
TOWSON
MD
212865811
Practice Location Phone/Fax
| Phone: | 4102041860 |
| Fax: |
Provider Mailing Location
1220 E JOPPA RD
TOWSON
MD
212865811
Provider Mailing Phone/Fax
| Phone: | 4102041860 |
| Fax: |