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General NPI Number Information
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NPI Number | 1699328377
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Entity Type | Individual
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Provider Name | MISS JAIDYN CLAIRE KATUTIS
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 1701 PARK CENTER DR STE 202
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City | ORLANDO
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State | FL
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Zip | 32835-6235
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Country | US
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Telephone | 407-286-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 640 GLENVIEW DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-2206
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Country | US
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Telephone | 321-352-1658
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 19-77887
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License Number State | FL
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