Provider Demographics
NPI:1730677634
Name:MATHERLY, KAYDEE MAE (RBT)
Entity Type:Individual
Prefix:
First Name:KAYDEE
Middle Name:MAE
Last Name:MATHERLY
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 1:11154 SCENIC VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8619
Mailing Address - Country:US
Mailing Address - Phone:661-902-3128
Mailing Address - Fax:
Practice Address - Street 1:11154 SCENIC VISTA DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8619
Practice Address - Country:US
Practice Address - Phone:661-902-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-54205106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician