Healthcare Provider Details

I. General information

NPI: 1265213086
Provider Name (Legal Business Name): KATELYN RILEY PEASE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 BAY PLAZA BLVD
TAMPA FL
33619-4466
US

IV. Provider business mailing address

9225 BAY PLAZA BLVD
TAMPA FL
33619-4466
US

V. Phone/Fax

Practice location:
  • Phone: 813-814-2000
  • Fax:
Mailing address:
  • Phone: 813-814-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2826909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: