MEDICARE: MISS JAIDYN CLAIRE KATUTIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	19-77887	FL

General Provider Information

NPI Number	:	1699328377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAIDYN CLAIRE KATUTIS

Provider Business Mailing Address
First Line	:	640 GLENVIEW DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2206
Country	:	US
Telephone Number	:	321-352-1658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 PARK CENTER DR STE 202
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6235
Country	:	US
Telephone Number	:	407-286-2021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	04/07/2022

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Directions to “ MISS JAIDYN CLAIRE KATUTIS ” Practice Location

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