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General NPI Number Information
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NPI Number | 1013713247
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Entity Type | Individual
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Provider Name | EZRA LEE DALTON
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Gender | Male
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 12760 W 87TH STREET PKWY STE 100
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City | LENEXA
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State | KS
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Zip | 66215-2878
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Country | US
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Telephone | 57-438-7431
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Fax |
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Provider Business Mailing Address
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Address Line | 12760 W 87TH STREET PKWY STE 100
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City | LENEXA
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State | KS
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Zip | 66215-2878
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-380196
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License Number State | IN
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