Provider Demographics
NPI:1639770860
Name:MARSH, KAILYE L (RBT)
Entity Type:Individual
Prefix:
First Name:KAILYE
Middle Name:L
Last Name:MARSH
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 1:768 E MICHIGAN ST UNIT 75
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4682
Mailing Address - Country:US
Mailing Address - Phone:321-543-5773
Mailing Address - Fax:
Practice Address - Street 1:768 E MICHIGAN ST UNIT 75
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4682
Practice Address - Country:US
Practice Address - Phone:321-543-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017422400Medicaid