=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396383436
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATELYN CATHERINE PIATT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2019
-----------------------------------------------------
Last Update Date | 10/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6976 PROFESSIONAL PKWY
-----------------------------------------------------
City | LAKEWOOD RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240-8414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-308-4641
-----------------------------------------------------
Fax | 941-342-6189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 INTERNATIONAL PKWY STE 200
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-915-7729
-----------------------------------------------------
Fax | 407-588-6294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-19-97222
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-23-68783
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------