Provider Demographics
NPI:1316414196
Name:MOORE, KAYLA MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 NW VIVION RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4555
Mailing Address - Country:US
Mailing Address - Phone:816-853-0946
Mailing Address - Fax:816-396-8809
Practice Address - Street 1:1460 NW VIVION RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4555
Practice Address - Country:US
Practice Address - Phone:816-853-0946
Practice Address - Fax:816-396-8809
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16-22709106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
16-22709OtherBACB