Healthcare Provider Details

I. General information

NPI: 1326653981
Provider Name (Legal Business Name): KILEY KOZLOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HILLER RD
ROCHESTER MA
02770-4024
US

IV. Provider business mailing address

90 SCHOOL ST
MIDDLEBORO MA
02346-2514
US

V. Phone/Fax

Practice location:
  • Phone: 774-454-1994
  • Fax: 508-273-2353
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: