Provider Demographics
NPI:1114610185
Name:MILES, KATHRYN (RBT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MILES
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 STERLING RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7690
Mailing Address - Country:US
Mailing Address - Phone:574-904-8545
Mailing Address - Fax:
Practice Address - Street 1:576 STERLING RESERVE WAY
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-7690
Practice Address - Country:US
Practice Address - Phone:574-904-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-250109106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician