Healthcare Provider Details

I. General information

NPI: 1730900853
Provider Name (Legal Business Name): MISS NOTLIE C LAMMIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MIRACLE STRIP PKWY STE 503
MARY ESTHER FL
32569-1991
US

IV. Provider business mailing address

6 BOBOLINK ST NE UNIT 201
FORT WALTON BEACH FL
32548-4996
US

V. Phone/Fax

Practice location:
  • Phone: 850-374-3748
  • Fax: 855-445-0214
Mailing address:
  • Phone: 850-240-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24384883
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: