Provider Demographics
NPI:1609769124
Name:BLANK, KATHERINE (RBT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BLANK
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 1:6235 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-4323
Mailing Address - Country:US
Mailing Address - Phone:616-296-1002
Mailing Address - Fax:
Practice Address - Street 1:9405 BARNSTEAD LN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4302
Practice Address - Country:US
Practice Address - Phone:727-967-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician