Provider Demographics
NPI:1114462009
Name:O'BRIEN, KAISEA LANE (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KAISEA
Middle Name:LANE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8865 NORWIN AVE STE 27
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2769
Mailing Address - Country:US
Mailing Address - Phone:186-628-7203
Mailing Address - Fax:866-418-4776
Practice Address - Street 1:48 N CENTRE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2306
Practice Address - Country:US
Practice Address - Phone:866-287-2036
Practice Address - Fax:866-418-4778
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-15-05496106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician