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NPI Code Detail

MEDICARE: KELLY TAYLOR BCBA

MEDICARE: KELLY TAYLOR BCBA
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
1103K00000XBehavior Analyst1-21-54515

General Provider Information

NPI Number : 1144694928
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY TAYLOR BCBA
Provider Business Mailing Address
First Line : PO BOX 931142
Second Line :
City : ATLANTA
State : GA
Zip : 31193-1142
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3820 FABER PLACE DR STE 600
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-8548
Country : US
Telephone Number : 843-352-7049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2015
Last Update Date : 12/03/2024

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