Provider Demographics
NPI:1174238430
Name:PONCE DE LEON, KAYLA (RBT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PONCE DE LEON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:KERVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:463-223-4591
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:4150 FORD ST STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9498
Practice Address - Country:US
Practice Address - Phone:239-291-5088
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician