Provider Demographics
NPI:1700675709
Name:HAMILTON, KAYLEE (RBT)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:HAMILTON
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 1:3025 FOUNTAIN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3690
Mailing Address - Country:US
Mailing Address - Phone:501-269-1656
Mailing Address - Fax:
Practice Address - Street 1:4300 ROGERS AVE STE 26
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3152
Practice Address - Country:US
Practice Address - Phone:501-269-1656
Practice Address - Fax:501-325-1255
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-25-429073106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician