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General NPI Number Information
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NPI Number | 1245830785
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Entity Type | Individual
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Provider Name | KEITH MARLEY THOMPSON BS
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 6885 B-5 SW 18TH ST.
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City | BOCA RATON
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State | FL
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Zip | 33433
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Country | US
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Telephone | 561-271-8768
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Fax | 954-425-6411
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Provider Business Mailing Address
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Address Line | 6885 B-5 SW 18TH ST.
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City | BOCA RATON
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State | FL
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Zip | 33433
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Country | US
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Telephone | 561-271-8768
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Fax | 954-425-6411
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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 | RB7-20-139856
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License Number State | FL
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