Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003393596 |
---|---|
Provider Name | Mykayla Montgomery |
First Address | Sacramento, CA 95815-4235 |
Second Address | Sacramento, CA 95815-4235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2018 |
Last Update Date | 26/07/2018 |