Individual
ANTIQUE JETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
936 MIDDLEBOROUGH RD, ESSEX, MD 21221-5942
(443) 766-4652
Mailing address
1301 E ORANGEWOOD AVE, ANAHEIM, CA 92805-6807
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MD
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/04/2023
Last updated
01/04/2023
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