Individual
THERESA REILLY FIELSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
308 MOHEGAN AVE., 7102, BLUFFTON, SC 29910
(231) 557-1155
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
(855) 832-6727
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/11/2023
Last updated
12/13/2023
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