Michaela Grace Mathis-Hagarty
Behavior Technician in Port Charlotte, FL. Individual provider (NPI-1).
NPI number1053074591
StatusActive
Last updated in NPPESOct 21, 2021
Details
- NPI
- 1053074591
- Entity type
- Individual (NPI-1)
- Name
- Michaela Grace Mathis-Hagarty
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 21, 2021
- Certification date
- Oct 21, 2021
- Last updated
- Oct 21, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
1475 Collingswood Blvd Unit GPort Charlotte, FL 33948-1059
Phone 941-999-4917
Mailing address
1475 Collingswood Blvd Unit GPort Charlotte, FL 33948-1059
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