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General NPI Number Information
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NPI Number | 1649742677
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Entity Type | Individual
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Provider Name | REBECCA M KELLETT BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/02/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2767 E US HIGHWAY 6
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City | KENDALLVILLE
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State | IN
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Zip | 46755-9341
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Country | US
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Telephone | 260-336-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 2767 E US HIGHWAY 6
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City | KENDALLVILLE
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State | IN
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Zip | 46755-9341
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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 | 17-46367
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-41466
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License Number State | IN
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