Healthcare Provider Details

I. General information

NPI: 1609642032
Provider Name (Legal Business Name): KK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W 76TH ST STE 212
HIALEAH FL
33016-5503
US

IV. Provider business mailing address

2100 W 76TH ST STE 212
HIALEAH FL
33016-5503
US

V. Phone/Fax

Practice location:
  • Phone: 305-321-0903
  • Fax:
Mailing address:
  • Phone: 305-321-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: VIVIANA CARIDAD PRIETO
Title or Position: RBT
Credential:
Phone: 305-321-0903