Mya Antonette Watson-Blake, RBT

NPI #1205571130 in O Fallon, Illinois

Provider Information

NPI Number: 1205571130
Entity Type: Individual
Name: Mya Antonette Watson-Blake, RBT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Credential: RBT
Enumeration Date: May 4, 2022
Last Updated: May 4, 2022

Practice Location

Address: 145 SPRINGFIELD CT
City: O Fallon
State: Illinois
ZIP Code: 62269-2495
Phone: (217) 525-8332

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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