MEDICARE: KEZIAH COSBY

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	RBT-24-392698

General Provider Information

NPI Number	:	1407663479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEZIAH COSBY

Provider Business Mailing Address
First Line	:	212 LAKE POINTE DR APT 307
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-7714
Country	:	US
Telephone Number	:	561-380-1326
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 N UNIVERSITY DR STE 405
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4151
Country	:	US
Telephone Number	:	754-229-2323
Fax Number	:

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

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/13/2024

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Directions to “ KEZIAH COSBY ” Practice Location

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