MEDICARE: KELSEY SUE SAYLOR RBT-16-26048

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	16-26048	IN

General Provider Information

NPI Number	:	1780150094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY SUE SAYLOR RBT-16-26048

Provider Business Mailing Address
First Line	:	2270 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5359
Country	:	US
Telephone Number	:	260-444-5649
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5359
Country	:	US
Telephone Number	:	260-444-5649
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	02/13/2025

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