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General NPI Number Information
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NPI Number | 1063235612
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Entity Type | Individual
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Provider Name | MITCHELL WILLIAM BLAUSER
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Gender | Male
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3580 HARGRAVE CT
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City | HEBRON
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State | KY
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Zip | 41048-6900
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Country | US
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Telephone | 855-444-5664
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Fax |
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Provider Business Mailing Address
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Address Line | 4767 HOUSTON RD APT 3313
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City | FLORENCE
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State | KY
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Zip | 41042-4817
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Country | US
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Telephone | 614-999-4460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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