Most Relevant Information
Provider Data
| NPI Number: | 1003581810 |
| Provider Name: | BLAIRE KIDWELL RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-21-177138 |
Most Important Dates
| Enumeration Date: | 08/13/2021 |
| Last Updated: | 08/13/2021 |
Provider Practice Location
215 S HURSTBOURNE PKWY STE 213
LOUISVILLE
KY
402224937
Practice Location Phone/Fax
| Phone: | 5023532074 |
| Fax: | 3175208200 |
Provider Mailing Location
3500 DEPAUW BLVD STE 3070
INDIANAPOLIS
IN
462686135
Provider Mailing Phone/Fax
| Phone: | 8553240885 |
| Fax: | 3175208200 |