Healthcare Provider Details

I. General information

NPI: 1700369618
Provider Name (Legal Business Name): MARISA SUZANNE GELINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 E OAK ST
KISSIMMEE FL
34744-5834
US

IV. Provider business mailing address

3208 NEEDLEGRASS LN
HARMONY FL
34773-6090
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-9520
  • Fax:
Mailing address:
  • Phone: 407-235-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: