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General NPI Number Information
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NPI Number | 1154025781
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Entity Type | Individual
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Provider Name | DEREK EDWARD VOLLER
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Gender | Male
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 325 LOGAN ST
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City | LYONS
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State | NE
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Zip | 68038-2603
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Country | US
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Telephone | 605-787-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 6214 24TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-3319
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Country | US
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Telephone |
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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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