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Individual

MOISE VIDRO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RBT

Contact information

Practice address
2707 FLORENCE DR, HOPKINSVILLE, KY 42240-1637
(803) 201-0792
Mailing address
2707 FLORENCE DR, HOPKINSVILLE, KY 42240-1637
(803) 201-0792

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-175735
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RBT-21-175735
BEHAVIOR TECHNICIAN
TN
Enumeration date
07/27/2021
Last updated
09/13/2023
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