MEDICARE: WALTER MONTGOMERY BYINGTON V BT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1184595357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER MONTGOMERY BYINGTON V BT

Provider Business Mailing Address
First Line	:	PO BOX 491
Second Line	:
City	:	HOWARD CITY
State	:	MI
Zip	:	49329-0491
Country	:	US
Telephone Number	:	231-349-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 S ENSLEY ST
Second Line	:
City	:	HOWARD CITY
State	:	MI
Zip	:	49329-8656
Country	:	US
Telephone Number	:	231-249-0706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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