Provider Demographics
NPI:1609383975
Name:PERRINGTON, KAILA
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:PERRINGTON
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 1:1242 SW PINE ISLAND RD STE 42-302
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2120
Mailing Address - Country:US
Mailing Address - Phone:239-910-0712
Mailing Address - Fax:317-774-5004
Practice Address - Street 1:12438 BRANTLEY COMMONS CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5683
Practice Address - Country:US
Practice Address - Phone:239-349-3139
Practice Address - Fax:239-984-4372
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-91318106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023128100Medicaid