Individual
KAYLENE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3130 STATE LINE RD, NORTH BEND, OH 45052-9731
(765) 580-9423
Mailing address
3130 STATE LINE RD, NORTH BEND, OH 45052-9731
(765) 580-9423
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-411012
—
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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