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NPI Code Detail

MEDICARE: KATHRYN LEIGH GREGORY BT

MEDICARE: KATHRYN LEIGH GREGORY BT
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
1103K00000XBehavior Analyst
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1932814811
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN LEIGH GREGORY BT
Provider Business Mailing Address
First Line : 1212 PURDUE DR
Second Line :
City : DAVIS
State : CA
Zip : 95616-1738
Country : US
Telephone Number : 619-723-3137
Fax Number :
Provider Business Practice Location Address
First Line : 5063 MAPLE RD
Second Line :
City : VACAVILLE
State : CA
Zip : 95687-9468
Country : US
Telephone Number : 619-723-3137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2023
Last Update Date : 01/25/2023

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