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General NPI Number Information
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NPI Number | 1235625526
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Entity Type | Individual
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Provider Name | MARTHA BEATRICE MATTHEWS RBT
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Gender | Female
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 1100 CIRCLE DR
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City | FORT WORTH
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State | TX
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Zip | 76119-8111
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Country | US
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Telephone | 817-566-1105
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Fax | 817-536-6945
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Provider Business Mailing Address
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Address Line | 10503 METRIC DR
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City | DALLAS
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State | TX
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Zip | 75243-5514
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Country | US
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Telephone | 972-644-2076
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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 | 18-48147
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License Number State | TX
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