Provider Demographics
NPI:1336857424
Name:ORTA, KIESLINGT OMAIDA (RBT)
Entity type:Individual
Prefix:
First Name:KIESLINGT
Middle Name:OMAIDA
Last Name:ORTA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9541 SW 171ST PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2983
Mailing Address - Country:US
Mailing Address - Phone:786-346-6695
Mailing Address - Fax:
Practice Address - Street 1:14331 SW 120TH ST STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7297
Practice Address - Country:US
Practice Address - Phone:305-408-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician