Healthcare Provider Details

I. General information

NPI: 1841107364
Provider Name (Legal Business Name): KAITLAN GRAY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 DAIRY ASHFORD RD STE 108
SUGAR LAND TX
77478-6215
US

IV. Provider business mailing address

PO BOX 151716
AUSTIN TX
78715-1716
US

V. Phone/Fax

Practice location:
  • Phone: 512-898-9044
  • Fax: 512-857-1423
Mailing address:
  • Phone: 512-898-9044
  • Fax: 512-857-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-518765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: