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General NPI Number Information
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NPI Number | 1790689065
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Entity Type | Individual
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Provider Name | ALAINA J KELLY
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Gender | Female
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 4365 STARKEY RD
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City | ROANOKE
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State | VA
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Zip | 24018-0610
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Country | US
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Telephone | 540-613-8339
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Fax | 540-527-5093
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Provider Business Mailing Address
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Address Line | 12276 SAN JOSE BLVD STE 508
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8618
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Country | US
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Telephone | 904-886-3228
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Fax | 904-485-8876
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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-25-452838
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License Number State | VA
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