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General NPI Number Information
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NPI Number | 1497454714
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Entity Type | Individual
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Provider Name | MAKENNA JANE COOLEY
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Gender | Female
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 4005 AMBERGRIS DR APT 213
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City | LUTZ
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State | FL
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Zip | 33559-6956
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Country | US
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Telephone | 920-492-9553
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Fax |
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Provider Business Mailing Address
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Address Line | 4005 AMBERGRIS DR APT 213
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City | LUTZ
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State | FL
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Zip | 33559-6956
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Country | US
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Telephone | 920-492-9553
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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-23-259878
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 02516142
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License Number State | FL
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