Healthcare Provider Details

I. General information

NPI: 1609502855
Provider Name (Legal Business Name): KAYLIE ELAINE REGISTER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 S BRANNON STAND RD
DOTHAN AL
36305-7005
US

IV. Provider business mailing address

2363 S BRANNON STAND RD
DOTHAN AL
36305-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-618-6809
  • Fax:
Mailing address:
  • Phone: 334-618-6809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86755
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: