Kaitlyn Marie Boland, RBT

Individual provider Active NPI Behavior Technician · Milton, FL

NPI 1760264170 · NPPES record last updated Jan 19, 2024

Key facts

NPI
1760264170
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
License
RBT-23-311501
Practice address
4629 Church St
Milton, FL 32583-4107
Phone
(850) 503-6636
Fax
(850) 626-6132
NPI assigned
Oct 19, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelong Behavioral Services, LLC Current
since Jan 21, 2024
Accepting new patients
Kaleidoscope Behavior Services Past
since Oct 1, 2023
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-23-311501 Yes

Addresses

Primary practice location

4629 Church St
Milton, FL 32583-4107

Mailing address

4629 Church St
Milton, FL 32583-4107
Phone (850) 503-6636

Other providers in Milton, FL

All providers in Milton, FL · Behavior Technician in Florida

Sources for this page

Verify at the official NPI Registry.