Provider Demographics
NPI:1386464469
Name:MARRIOTT, BREA R (RBT)
Entity type:Individual
Prefix:
First Name:BREA
Middle Name:R
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6910 SILVERHEEL ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-5316
Mailing Address - Country:US
Mailing Address - Phone:913-405-4550
Mailing Address - Fax:913-273-2452
Practice Address - Street 1:6910 SILVERHEEL ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-5316
Practice Address - Country:US
Practice Address - Phone:913-405-4550
Practice Address - Fax:913-273-2452
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS22-225864106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician