Individual
HEATHER RENEE FAIRLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
32 MILLBRANCH RD STE 40, HATTIESBURG, MS 39402-1673
(601) 255-5264
Mailing address
2612 N 9TH ST, OCEAN SPRINGS, MS 39564-1008
(228) 493-9583
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-47592
MS
Other
Enumeration date
02/26/2019
Last updated
02/26/2019
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