Healthcare Provider Details

I. General information

NPI: 1255168076
Provider Name (Legal Business Name): KELLY M ALLEN RBT-24-354014
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6208 CEDELIA RD
BOKEELIA FL
33922-2350
US

IV. Provider business mailing address

6208 CEDELIA RD
BOKEELIA FL
33922-2350
US

V. Phone/Fax

Practice location:
  • Phone: 239-741-0970
  • Fax:
Mailing address:
  • Phone: 239-841-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-354014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: