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General NPI Number Information
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NPI Number | 1568027225
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Entity Type | Organization
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Legal Business Name | KEYS KIDS ABA
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 9 TRANSYLVANIA AVE
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City | KEY LARGO
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State | FL
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Zip | 33037-4717
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Country | US
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Telephone | 321-482-6866
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Fax |
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Provider Business Mailing Address
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Address Line | 1796 ASHCROFT ST NW
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City | PALM BAY
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State | FL
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Zip | 32907-9474
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Country | US
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Telephone | 321-482-6866
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELISSA A WILBRANDT
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Credential | MBA
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Telephone | 321-482-6866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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