MEDICARE: KAYLA BARY MA, 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
1	103K00000X	Behavior Analyst	BACB440229	IN

General Provider Information

NPI Number	:	1629749098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA BARY MA, BCBA

Provider Business Mailing Address
First Line	:	2270 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5359
Country	:	US
Telephone Number	:	260-444-5649
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5359
Country	:	US
Telephone Number	:	260-444-5649
Fax Number	:

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

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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