Healthcare Provider Details

I. General information

NPI: 1104655711
Provider Name (Legal Business Name): BRITANY KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITANY ANNE SANCHEZ

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NEWMAN ST
EAST TAWAS MI
48730-1272
US

IV. Provider business mailing address

14491 M 65
POSEN MI
49776-9455
US

V. Phone/Fax

Practice location:
  • Phone: 989-334-4837
  • Fax:
Mailing address:
  • Phone: 989-255-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: