MEDICARE: MAKAYLA SARGENT

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	12-39288	IN

General Provider Information

NPI Number	:	1457868051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAYLA SARGENT

Provider Business Mailing Address
First Line	:	612 E BOULEVARD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-2271
Country	:	US
Telephone Number	:	765-271-8088
Fax Number	:	765-452-5207

Provider Business Practice Location Address
First Line	:	612 E BOULEVARD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-2271
Country	:	US
Telephone Number	:	765-271-8088
Fax Number	:	765-452-5207

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

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	01/04/2018

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Directions to “ MAKAYLA SARGENT ” Practice Location

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