1245725225 NPI number — KAITLYN BROOKE OSBORNE-BIAS BCBA

Table of content: KAITLYN BROOKE OSBORNE-BIAS BCBA (NPI 1245725225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245725225 NPI number — KAITLYN BROOKE OSBORNE-BIAS BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSBORNE-BIAS
Provider First Name:
KAITLYN
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245725225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11214 OAK TREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALADO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76571-5322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-289-9892
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 W CENTRAL TEXAS EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76541-2573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-279-3426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  4867 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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