Healthcare Provider Details

I. General information

NPI: 1972320158
Provider Name (Legal Business Name): KAYLEE STATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 CELANESE RD STE 105
ROCK HILL SC
29732-2994
US

IV. Provider business mailing address

PO BOX 931142
ATLANTA GA
31193-1142
US

V. Phone/Fax

Practice location:
  • Phone: 803-366-6250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-435581
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: