Healthcare Provider Details

I. General information

NPI: 1043977515
Provider Name (Legal Business Name): MARIETTA FINKLEY ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 SW 25TH DR APT 1
GAINESVILLE FL
32608-2819
US

IV. Provider business mailing address

3212 SW 25TH DR APT 1
GAINESVILLE FL
32608-2819
US

V. Phone/Fax

Practice location:
  • Phone: 859-248-0351
  • Fax:
Mailing address:
  • Phone: 859-248-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number7265
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: