Johntavia Wallace
Johntavia Wallace is a Behavior Technician in Brandon, Florida. Registered with an NPI since 2022.
- In the registry since
- 2022
Practice location Address checks out
220 Grand Regency BlvdBrandon, FL 33510-3935
Phone: (813) 709-7989
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Behavior Technician (primary) | Taxonomy 106S00000X |
|---|
Record details
| NPI number | 1821726704 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | No |
| NPI enumerated | August 10, 2022 |
| Last updated in NPPES | August 10, 2022 |
| Certification date | August 10, 2022 |
| Mailing address | 3500 Depauw Blvd Ste 3070, Indianapolis, IN 46268-6135 |
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