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NPI Code Detail

MEDICARE: MARY ALEXANDRA WORKMAN RBT

MEDICARE: MARY ALEXANDRA WORKMAN 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 Technician
2103K00000XBehavior Analyst1-22-60280AR

General Provider Information

NPI Number : 1932617875
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ALEXANDRA WORKMAN RBT
Provider Business Mailing Address
First Line : 50 COUNTRY TRL
Second Line :
City : QUITMAN
State : AR
Zip : 72131-8698
Country : US
Telephone Number : 501-691-2009
Fax Number :
Provider Business Practice Location Address
First Line : 1301 MUSEUM RD
Second Line :
City : CONWAY
State : AR
Zip : 72032-4739
Country : US
Telephone Number : 501-358-6535
Fax Number : 501-358-6536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2018
Last Update Date : 07/08/2022

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Directions to “ MARY ALEXANDRA WORKMAN RBT” Practice Location

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