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General NPI Number Information
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NPI Number | 1689494627
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Entity Type | Individual
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Provider Name | BURGANDY WATKINS
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1800 S 35TH ST
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City | GALESBURG
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State | MI
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Zip | 49053-9688
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Country | US
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Telephone | 269-250-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 5044 COOPERS LANDING DR APT 2B
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City | KALAMAZOO
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State | MI
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Zip | 49004-6652
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Country | US
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Telephone | 269-290-5774
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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 | MI
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