Healthcare Provider Details

I. General information

NPI: 1033838545
Provider Name (Legal Business Name): KAITLYN WATKINS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W OAK ST
WASHINGTON IN
47501-3425
US

IV. Provider business mailing address

520 WASHINGTON ST
ROCKPORT IN
47635-1247
US

V. Phone/Fax

Practice location:
  • Phone: 812-747-9209
  • Fax:
Mailing address:
  • Phone: 812-677-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90837
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: