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General NPI Number Information
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NPI Number | 1962700856
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Entity Type | Individual
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Provider Name | KEATHER KENT BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 180 ROBERT CURRY DR
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City | MARTINSVILLE
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State | IN
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Zip | 46151-8076
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Country | US
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Telephone | 463-201-6463
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Fax | 314-245-3401
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Provider Business Mailing Address
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Address Line | 1375 E MORGAN ST.
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City | MARTINSVILLE
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State | IN
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Zip | 46151
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Country | US
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Telephone |
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Fax | 317-842-5911
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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 | 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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