Healthcare Provider Details

I. General information

NPI: 1295283802
Provider Name (Legal Business Name): KIARA GATTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPRINGBROOKE BLVD STE 109
ASTON PA
19014-3100
US

IV. Provider business mailing address

100 SPRINGBROOKE BLVD STE 109
ASTON PA
19014-3100
US

V. Phone/Fax

Practice location:
  • Phone: 484-482-3462
  • Fax:
Mailing address:
  • Phone: 484-482-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008589
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: