Provider Demographics
NPI:1922899285
Name:PETERS, KAILE TERIN
Entity type:Individual
Prefix:
First Name:KAILE
Middle Name:TERIN
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 CAMINO VAQUERO PKWY APT 4209
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-1006
Mailing Address - Country:US
Mailing Address - Phone:310-346-8528
Mailing Address - Fax:
Practice Address - Street 1:601 S LAKE DESTINY RD STE 350
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7222
Practice Address - Country:US
Practice Address - Phone:737-346-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician