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NPI Code Detail

MEDICARE: AMY LYNN LARSON RBT

MEDICARE: AMY LYNN LARSON RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-19-92555

General Provider Information

NPI Number : 1841843091
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LYNN LARSON RBT
Provider Business Mailing Address
First Line : 710 BUFFALO ST STE 802
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78401-1902
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 710 BUFFALO ST STE 802
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78401-1902
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2019
Last Update Date : 07/17/2019

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Directions to “ AMY LYNN LARSON RBT” Practice Location

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