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General NPI Number Information
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NPI Number | 1346834611
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Entity Type | Individual
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Provider Name | JAIME WHALLEY RBT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 113G N MARINE BLVD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-6508
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Country | US
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Telephone | 910-389-0901
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Fax |
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Provider Business Mailing Address
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Address Line | 715 STONEWALL AVE
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City | JACKSONVILLE
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State | NC
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Zip | 28540-8837
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Country | US
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Telephone | 765-427-9943
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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 | RBT21-157464
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License Number State | NC
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