Provider Demographics
NPI:1508477647
Name:RAPER, KAELA MICHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:MICHELLE
Last Name:RAPER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8945
Mailing Address - Country:US
Mailing Address - Phone:904-228-0036
Mailing Address - Fax:
Practice Address - Street 1:1631 SIMMONS RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-8945
Practice Address - Country:US
Practice Address - Phone:904-228-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst