Provider Demographics
NPI:1376144824
Name:SPEIGHTS, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SPEIGHTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4472
Mailing Address - Country:US
Mailing Address - Phone:386-383-4562
Mailing Address - Fax:386-256-2320
Practice Address - Street 1:140 S BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4472
Practice Address - Country:US
Practice Address - Phone:386-383-4562
Practice Address - Fax:386-256-2320
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-142492106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-142492OtherREGISTERED BEHAVIOR TECHNICIAN CERTIFICATE LETTER