Provider Demographics
NPI:1982289948
Name:ANDERSON, KAELEE MAE (RBT)
Entity Type:Individual
Prefix:
First Name:KAELEE
Middle Name:MAE
Last Name:ANDERSON
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:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-1076
Mailing Address - Country:US
Mailing Address - Phone:352-348-6244
Mailing Address - Fax:
Practice Address - Street 1:2437 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9105
Practice Address - Country:US
Practice Address - Phone:352-509-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-5-19205106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician