Individual
JEREMY PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 SPENRYN DR, MADISON, AL 35758-1890
(256) 910-8466
Mailing address
2502 JERI ST NW, HUNTSVILLE, AL 35810-1932
(256) 910-8466
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-250369
AL
106S00000X
Behavior Technician
RBT22-250369
AL
Other
Enumeration date
01/03/2023
Last updated
01/03/2023
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