Healthcare Provider Details

I. General information

NPI: 1164930897
Provider Name (Legal Business Name): PATRICK L STEWART JR. RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W JASPER DR
KILLEEN TX
76542-1312
US

IV. Provider business mailing address

504 W JASPER DR
KILLEEN TX
76542-1312
US

V. Phone/Fax

Practice location:
  • Phone: 254-721-0797
  • Fax:
Mailing address:
  • Phone: 254-721-0797
  • 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: