Most Relevant Information
Provider Data
| NPI Number: | 1003681198 |
| Provider Name: | KEVIN MBOMA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-23-311070 |
Most Important Dates
| Enumeration Date: | 11/17/2023 |
| Last Updated: | 11/17/2023 |
Provider Practice Location
1337 S FOUNTAIN DR
OLATHE
KS
660617205
Practice Location Phone/Fax
| Phone: | 9133791656 |
| Fax: | 8006875070 |
Provider Mailing Location
4721 S CLIFF AVE STE 103
INDEPENDENCE
MO
640556969
Provider Mailing Phone/Fax
| Phone: | 8166081956 |
| Fax: | 8006875070 |