=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174477137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAILEY BROOKS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 803 LYNNWOOD DR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-6213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-266-3657
-----------------------------------------------------
Fax | 336-266-3657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 803 LYNNWOOD DR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-6213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 000049050663
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------