=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053122218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE LYNDA OSBORNE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2025
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 HOLLOWAY ST
-----------------------------------------------------
City | WALHALLA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29691-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-254-7861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 HOLLOWAY ST
-----------------------------------------------------
City | WALHALLA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29691-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-254-7861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 106004749
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 4174
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------