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NPI Code Detail

MEDICARE: KELSEY LEIGH BLIK

MEDICARE: KELSEY LEIGH BLIK
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1417706425
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY LEIGH BLIK
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-244-1818
Fax Number :
Provider Business Practice Location Address
First Line : 2965 FORT CAMPBELL BLVD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042-7798
Country : US
Telephone Number : 931-271-4850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2024
Last Update Date : 05/14/2024

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Directions to “ KELSEY LEIGH BLIK ” Practice Location

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