Individual
BREANA MOULTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3580 MCGEHEE PLACE DR S APT 3404, MONTGOMERY, AL 36111-3352
(205) 746-4472
Mailing address
3580 MCGEHEE PLACE DR S APT 3404, MONTGOMERY, AL 36111-3352
(205) 746-4472
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
9417821
AL
Other
Enumeration date
07/12/2024
Last updated
07/12/2024
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