Individual
BO RAM ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7608 NARROW PASS ST, LIVE OAK, TX 78233-3019
(210) 714-3545
Mailing address
7608 NARROW PASS ST, LIVE OAK, TX 78233-3019
(210) 714-3545
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-191635
TX
Other
Enumeration date
11/16/2021
Last updated
11/16/2021
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