Provider Demographics
NPI:1679314488
Name:FRYE, KATRINA (RBT)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:FRYE
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 1:612 E BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2271
Mailing Address - Country:US
Mailing Address - Phone:765-461-1245
Mailing Address - Fax:
Practice Address - Street 1:2430 S BUSINESS 31
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-7188
Practice Address - Country:US
Practice Address - Phone:765-460-5071
Practice Address - Fax:765-319-0660
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-23-288563106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician