Healthcare Provider Details

I. General information

NPI: 1437012812
Provider Name (Legal Business Name): KAELA MAYREE HUDNALL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RUBY ST
OPP AL
36467-9782
US

IV. Provider business mailing address

100 RUBY ST
OPP AL
36467-9782
US

V. Phone/Fax

Practice location:
  • Phone: 334-804-0143
  • Fax:
Mailing address:
  • Phone: 334-804-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-457716
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: