MEDICARE: KAYLEE MAPLE RBT

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	1-24-73166	FL
2	106S00000X	Behavior Technician	RBT-22-211529	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659003358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE MAPLE RBT

Provider Business Mailing Address
First Line	:	210 S MACDILL AVE # A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3131
Country	:	US
Telephone Number	:	813-475-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S MACDILL AVE # A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3131
Country	:	US
Telephone Number	:	813-475-4665
Fax Number	:

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

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	05/23/2024

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Directions to “ KAYLEE MAPLE RBT” Practice Location

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