Healthcare Provider Details

I. General information

NPI: 1154135788
Provider Name (Legal Business Name): SHAYLEE KAYE CHOULES RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4943 N 29TH E # B
IDAHO FALLS ID
83401-1314
US

IV. Provider business mailing address

1603 CAPITOL AVE STE 415
CHEYENNE WY
82001-4562
US

V. Phone/Fax

Practice location:
  • Phone: 307-257-5487
  • Fax:
Mailing address:
  • Phone: 307-257-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2857888
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-407567
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: