Healthcare Provider Details

I. General information

NPI: 1164189767
Provider Name (Legal Business Name): KAYLA LOUISE YEARWOOD RBT-21-183066
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA PHILLIPS

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WEATHERSTONE DR STE 530
WOODSTOCK GA
30188-7006
US

IV. Provider business mailing address

107 WEATHERSTONE DR STE 530
WOODSTOCK GA
30188-7006
US

V. Phone/Fax

Practice location:
  • Phone: 770-591-9552
  • Fax: 800-218-8249
Mailing address:
  • Phone: 770-591-9552
  • Fax: 800-218-8249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-183066
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: