Provider Demographics
NPI:1447317144
Name:FAGALA, KELLY KAY (BCBA, MA, MT-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KAY
Last Name:FAGALA
Suffix:
Gender:F
Credentials:BCBA, MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 SUMMIT PLACE CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3573
Mailing Address - Country:US
Mailing Address - Phone:636-305-1614
Mailing Address - Fax:
Practice Address - Street 1:453 SUMMIT PLACE CT
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3573
Practice Address - Country:US
Practice Address - Phone:314-258-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist