Individual
ALEXANDRA WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 MICHIGAN AVE STE J, KISSIMMEE, FL 34744-1214
(321) 355-3904
(407) 255-6429
Mailing address
13500 TURTLE MARSH LOOP APT 823, ORLANDO, FL 32837-6633
(912) 659-9442
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/12/2020
Last updated
09/12/2020
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