Healthcare Provider Details

I. General information

NPI: 1285248096
Provider Name (Legal Business Name): KATIE L KOZLOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 NW 6TH ST
GAINESVILLE FL
32601-4020
US

IV. Provider business mailing address

1408 NW 6TH ST
GAINESVILLE FL
32601-4020
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-4411
  • Fax: 352-373-4455
Mailing address:
  • Phone: 352-373-4411
  • Fax: 352-373-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: