Individual
MARANDA DARLINE BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
88 PANTHER DR, SPARTA, TN 38583-2601
(931) 738-3505
Mailing address
425 S YOUNG ST, SPARTA, TN 38583-1958
(931) 260-2024
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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