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NPI Code Detail

MEDICARE: CAITLIN MARIE KELLY BCBA

MEDICARE: CAITLIN MARIE KELLY BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1346701000
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAITLIN MARIE KELLY BCBA
Provider Business Mailing Address
First Line : 11412 N 134TH EAST AVE STE C3
Second Line :
City : OWASSO
State : OK
Zip : 74055-4969
Country : US
Telephone Number : 918-629-6330
Fax Number :
Provider Business Practice Location Address
First Line : 11412 N 134TH EAST AVE STE C3
Second Line :
City : OWASSO
State : OK
Zip : 74055-4969
Country : US
Telephone Number : 918-376-3087
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2019
Last Update Date : 05/15/2024

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Directions to “ CAITLIN MARIE KELLY BCBA” Practice Location

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