MEDICARE: KAIYA TODD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003704735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIYA TODD

Provider Business Mailing Address
First Line	:	800 W MARKET ST
Second Line	:
City	:	DIAMOND
State	:	MO
Zip	:	64840-7135
Country	:	US
Telephone Number	:	417-592-5688
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 N EIGHT TRIBES TRL
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-1011
Country	:	US
Telephone Number	:	918-387-8720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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Directions to “ KAIYA TODD ” Practice Location

Language	Start Address	Practice Location

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