Individual
KYLIE GAMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 ADRIS PL, DOTHAN, AL 36303-1997
(334) 618-3302
Mailing address
112 ADRIS PL, DOTHAN, AL 36303-1997
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-313444
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTHER
23-313444
—
Enumeration date
12/14/2023
Last updated
12/14/2023
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