Provider Demographics
NPI:1043025471
Name:COOMER, KAYTLIN DENISE (RBT)
Entity type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:DENISE
Last Name:COOMER
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 1:1409 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-2511
Mailing Address - Country:US
Mailing Address - Phone:765-520-8828
Mailing Address - Fax:
Practice Address - Street 1:3011 S 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1845
Practice Address - Country:US
Practice Address - Phone:765-465-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
INRBT-23-296379106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician