Individual
FANTASY SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
216 W BOYLSTON ST, WEST BOYLSTON, MA 01583-1784
(978) 407-5109
Mailing address
156 SANBORN ST, FITCHBURG, MA 01420-3758
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/27/2023
Last updated
12/27/2023
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