Provider Demographics
NPI:1316523202
Name:REID, KAITLYN NICOLE (RBT)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:NICOLE
Last Name:REID
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:NICOLE
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12918 OCEAN GLADE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4333
Mailing Address - Country:US
Mailing Address - Phone:830-388-2883
Mailing Address - Fax:
Practice Address - Street 1:14235 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7718
Practice Address - Country:US
Practice Address - Phone:210-415-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician