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General NPI Number Information
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NPI Number | 1023955283
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Entity Type | Individual
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Provider Name | KILEY MELLOTT RBT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 16620 N 40TH ST BLDG C
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City | PHOENIX
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State | AZ
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Zip | 85032-3348
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Country | US
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Telephone | 602-649-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 2246 W TONOPAH DR
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City | PHOENIX
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State | AZ
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Zip | 85027-3427
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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 | RBT-26-533786
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License Number State | AZ
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