Provider Demographics
NPI:1558853499
Name:HEAD, MARCQUITTA
Entity type:Individual
Prefix:
First Name:MARCQUITTA
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 DERBYSHIRE RD APT 278
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3964
Mailing Address - Country:US
Mailing Address - Phone:404-748-2425
Mailing Address - Fax:
Practice Address - Street 1:56 WATER ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2887
Practice Address - Country:US
Practice Address - Phone:727-364-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1283937OtherTEACHING CERTIFICATE