MEDICARE: KLBAC, INC.

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1992374102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLBAC, INC.

Provider Business Mailing Address
First Line	:	263 SAINT THOMAS AVE
Second Line	:
City	:	KEY LARGO
State	:	FL
Zip	:	33037-4321
Country	:	US
Telephone Number	:	305-764-2070
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 SAINT THOMAS AVE
Second Line	:
City	:	KEY LARGO
State	:	FL
Zip	:	33037-4321
Country	:	US
Telephone Number	:	305-764-2070
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	LIMAY PEREZ CHAVIANO
Credential	:
Telephone Number	:	305-764-2070

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/30/2021

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Directions to “KLBAC, INC. ” Practice Location

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