Healthcare Provider Details

I. General information

NPI: 1053927004
Provider Name (Legal Business Name): KATHRYN L MARSH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE MARSH

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 SW 16TH AVE
GAINESVILLE FL
32608-1158
US

IV. Provider business mailing address

1699 SW 16TH AVE
GAINESVILLE FL
32608-1158
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-1300
  • Fax:
Mailing address:
  • Phone: 352-334-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberPY11298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: