Individual
ALEXANDRA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 10TH AVE, SHALIMAR, FL 32579-1340
(850) 362-6824
Mailing address
103 LEWIS ST, FORT WALTON BEACH, FL 32547-3142
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/12/2017
Last updated
01/28/2025
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