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General NPI Number Information
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NPI Number | 1144010968
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Entity Type | Individual
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Provider Name | MRS. KYLA NICOLE JUNE MATTINGLY
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 730 SAND LAKE RD FL 32809
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City | ORLANDO
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State | FL
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Zip | 32809-7750
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Country | US
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Telephone | 407-214-5539
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 RANKIN ST
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City | KINDRED
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State | FL
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Zip | 34744-5755
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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-25-432816
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License Number State | FL
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