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NPI Code Detail

MEDICARE: KAITLYN ROSE RICHARDSON

MEDICARE: KAITLYN ROSE RICHARDSON
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
1106S00000XBehavior TechnicianRBT-25-415068AL

General Provider Information

NPI Number : 1417764374
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN ROSE RICHARDSON
Provider Business Mailing Address
First Line : 1690 BELTLINE RD SW STE B
Second Line :
City : DECATUR
State : AL
Zip : 35601-5621
Country : US
Telephone Number : 256-686-3169
Fax Number :
Provider Business Practice Location Address
First Line : 1690 BELTLINE RD SW STE B
Second Line :
City : DECATUR
State : AL
Zip : 35601-5621
Country : US
Telephone Number : 256-686-3169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2024
Last Update Date : 03/26/2025

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Directions to “ KAITLYN ROSE RICHARDSON ” Practice Location

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