| On Eagles Wings Aba | |
|
1941 Crape Myrtle Loop 205 Lutz FL 33549 | |
| (956) 454-8539 | |
| Not Available |
| Full Name | On Eagles Wings Aba |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1941 Crape Myrtle Loop, Lutz, Florida |
| Authorized Official Name and Position | Pearson Foss Klein (PRESIDENT) |
| Authorized Official Contact | 9564548539 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| On Eagles Wings Aba 1941 Crape Myrtle Loop Apt 205 205 Lutz FL 33549-4008 Ph: (956) 454-8539 | On Eagles Wings Aba 1941 Crape Myrtle Loop 205 Lutz FL 33549 Ph: (956) 454-8539 |
| NPI Number | 1760923437 |
|---|---|
| Provider Enumeration Date | 03/15/2017 |
| Last Update Date | 03/15/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760923437 | NPI | - | NPPES |
| 017539500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-12-10524 (Florida) | Primary |
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