Provider Demographics
NPI:1255168076
Name:ALLEN, KELLY M (RBT-24-354014)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RBT-24-354014
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 CEDELIA RD
Mailing Address - Street 2:
Mailing Address - City:BOKEELIA
Mailing Address - State:FL
Mailing Address - Zip Code:33922-2350
Mailing Address - Country:US
Mailing Address - Phone:239-841-0970
Mailing Address - Fax:
Practice Address - Street 1:6208 CEDELIA RD
Practice Address - Street 2:
Practice Address - City:BOKEELIA
Practice Address - State:FL
Practice Address - Zip Code:33922-2350
Practice Address - Country:US
Practice Address - Phone:239-741-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-354014106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician