MEDICARE: KELLEY WARD MS, 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

General Provider Information

NPI Number	:	1730560350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY WARD MS, BCBA

Provider Business Mailing Address
First Line	:	500 FAIRWAY DR
Second Line	:	SUITE 102
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1814
Country	:	US
Telephone Number	:	954-693-7885
Fax Number	:	954-342-0273

Provider Business Practice Location Address
First Line	:	4030 WAKE FOREST RD
Second Line	:	STE 349
City	:	RALEIGH
State	:	NC
Zip	:	27609-6800
Country	:	US
Telephone Number	:	954-693-7885
Fax Number	:	954-342-0273

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

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	07/10/2015

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