Provider Demographics
NPI:1417581075
Name:BAUTISTA, KAYLA AYERS (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:AYERS
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:VICTORIA
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LBA
Mailing Address - Street 1:1332 PLANTATION RD NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-5713
Mailing Address - Country:US
Mailing Address - Phone:540-795-3053
Mailing Address - Fax:855-847-6799
Practice Address - Street 1:1332 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:540-795-3053
Practice Address - Fax:855-847-6799
Is Sole Proprietor?:No
Enumeration Date:2020-02-22
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001663103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty