Individual
KATHLEEN FULKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 S BEACH ST STE 200, DAYTONA BEACH, FL 32114-4433
(386) 898-6040
(386) 256-2320
Mailing address
210 S BEACH ST STE 200, DAYTONA BEACH, FL 32114-4433
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-23-28263
FL
2355S0801X
Speech-Language Assistant
S17831
FL
252Y00000X
Early Intervention Provider Agency
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118810000
—
FL
01
—
RBT-23-282263
RBT
FL
01
—
S17831
SLPA
FL
Enumeration date
07/07/2023
Last updated
09/19/2025
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