Individual
CARLY GRACE SPONSELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
3403B GARDEN VILLA LN, AUSTIN, TX 78704-6915
(855) 832-6727
(772) 675-9100
Mailing address
8769 SUGAR GUM RD, RIVERSIDE, CA 92508-3065
(949) 750-9690
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
RBT-20-134539
TX
Other
Enumeration date
09/25/2020
Last updated
09/25/2020
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