Provider Demographics
NPI:1649846114
Name:MADDRY-SMITH, KELSEY ELIZABETH (RBT)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:MADDRY-SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 RICKEY AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2520
Mailing Address - Country:US
Mailing Address - Phone:682-216-6641
Mailing Address - Fax:850-937-7381
Practice Address - Street 1:103 RICKEY AVE UNIT C
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2520
Practice Address - Country:US
Practice Address - Phone:682-216-6641
Practice Address - Fax:850-937-7381
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician