Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-01-0573 | FL |
NPI | 1013208867 |
---|---|
Provider Name | Laquita Spivey Montgomery |
First Address | Grant, FL 32949-0230 |
Second Address | West Palm Beach, FL 33401-4610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 28/04/2011 |