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General NPI Number Information
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NPI Number | 1811648116
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Entity Type | Individual
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Provider Name | KELSEY RAY BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 5500 MURRELL RD STE 100
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City | MELBOURNE
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State | FL
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Zip | 32940-6700
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Country | US
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Telephone | 321-426-7759
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Fax | 321-593-0839
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Provider Business Mailing Address
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Address Line | 432 EASTWOOD RD STE 102
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City | WILMINGTON
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State | NC
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Zip | 28403-1873
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Country | US
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Telephone | 346-500-5842
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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-21-176351
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License Number State | FL
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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 | 1-25-80994
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License Number State | NC
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