Individual
ELIZABETH WHEATALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14 WALLINGFORD RD APT 2, BRIGHTON, MA 02135-4702
(907) 947-4048
Mailing address
14 WALLINGFORD RD APT 2, BRIGHTON, MA 02135-4702
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/03/2018
Last updated
04/03/2018
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