MEDICARE: KELLY ROBINSON 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		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT25491897	OTHER	IN	RBT

General Provider Information

NPI Number	:	1710788062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ROBINSON RBT

Provider Business Mailing Address
First Line	:	409 E OSAGE ST APT 211
Second Line	:
City	:	GREENFIELD
State	:	IN
Zip	:	46140-2492
Country	:	US
Telephone Number	:	317-488-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W PARK AVE
Second Line	:
City	:	GREENFIELD
State	:	IN
Zip	:	46140-1457
Country	:	US
Telephone Number	:	317-467-6731
Fax Number	:

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

Provider Enumeration Date	:	03/22/2025
Last Update Date	:	11/24/2025

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Directions to “ KELLY ROBINSON RBT” Practice Location

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