Basic Information
| Provider Information | |||||||||
| NPI: | 1063909091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOCKER | ||||||||
| FirstName: | GARRISON | ||||||||
| MiddleName: | RILEY | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4525 E CLINTON TRL | ||||||||
| Address2: | |||||||||
| City: | EATON RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488278368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695016587 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6267 WEBSTER CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | DEXTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481309659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342526522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2018 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | N | Eye and Vision Services Providers | Technician/Technologist | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.