Individual
MARCQUITTA HEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
56 WATER ST, ST AUGUSTINE, FL 32084-2887
(727) 364-4024
Mailing address
875 DERBYSHIRE RD APT 278, DAYTONA BEACH, FL 32117-3964
(404) 748-2425
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1283937
TEACHING CERTIFICATE
FL
Enumeration date
06/06/2018
Last updated
03/31/2020
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