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General NPI Number Information
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NPI Number | 1477283406
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Entity Type | Individual
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Provider Name | KYLA RUTH DAVIS
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Gender | Female
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 7220 W JEFFERSON AVE STE 100
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City | LAKEWOOD
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State | CO
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Zip | 80235-2015
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Country | US
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Telephone | 866-545-6069
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Fax |
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Provider Business Mailing Address
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Address Line | 1239 COUNTY ROAD 27
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City | MONTE VISTA
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State | CO
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Zip | 81144-9312
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Country | US
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Telephone | 719-588-4247
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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-22-220477
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License Number State | CO
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