MEDICARE: KATELYNN MARIE KOMARA

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	1615	NC

General Provider Information

NPI Number	:	1689209264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYNN MARIE KOMARA

Provider Business Mailing Address
First Line	:	4903 SAINT GEORGES DR N
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-9181
Country	:	US
Telephone Number	:	330-716-2685
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 WOOTEN BLVD SW
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-4426
Country	:	US
Telephone Number	:	919-375-0475
Fax Number	:

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

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	03/16/2026

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