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General NPI Number Information
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NPI Number | 1518354182
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Entity Type | Individual
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Provider Name | COURTNEY GATLIN
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Gender | Female
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 5535 S WILLIAMSON BLVD SUITE 774
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City | PORT ORANGE
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State | FL
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Zip | 32128-8311
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Country | US
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Telephone | 318-664-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 4847 TUSCAN LOON DR
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City | TAMPA
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State | FL
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Zip | 33619-0809
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Country | US
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Telephone | 318-664-6777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22774
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA14208
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License Number State | FL
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