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General NPI Number Information
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NPI Number | 1952089187
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Entity Type | Individual
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Provider Name | KATHLEEN FULKS
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Gender | Female
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 210 S BEACH ST STE 200
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4433
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Country | US
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Telephone | 386-898-6040
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Fax | 386-256-2320
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Provider Business Mailing Address
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Address Line | 210 S BEACH ST STE 200
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4433
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | S17831
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-28263
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License Number State | FL
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