Healthcare Provider Details

I. General information

NPI: 1619652773
Provider Name (Legal Business Name): KATELYN BAILEY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 10TH ST
GAS CITY IN
46933-1605
US

IV. Provider business mailing address

300 N 10TH ST
GAS CITY IN
46933-1605
US

V. Phone/Fax

Practice location:
  • Phone: 888-877-7222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-6289-1099984
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: