MEDICARE: KATELYNN MARIE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1376110056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYNN MARIE SMITH

Provider Business Mailing Address
First Line	:	1151 OCEAN SPRINGS RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3421
Country	:	US
Telephone Number	:	850-607-6910
Fax Number	:	850-607-6932

Provider Business Practice Location Address
First Line	:	1801 SE HILLMOOR DR STE B101-103
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7553
Country	:	US
Telephone Number	:	772-463-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	02/12/2026

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Directions to “ KATELYNN MARIE SMITH ” Practice Location

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