Individual
MAKAYLA BOSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1169 EASTERN PKWY STE G1111, LOUISVILLE, KY 40217-1462
(502) 242-9091
Mailing address
996 ROYAL MARCO WAY, MARCO ISLAND, FL 34145-1829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
B20-322-315
KY
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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