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NPI Code Detail

MEDICARE: KATHERINE AUGUSTINA GUSMAN BT

MEDICARE: KATHERINE AUGUSTINA GUSMAN BT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1417712209
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE AUGUSTINA GUSMAN BT
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 464099 STATE ROAD 200 STE 2
Second Line :
City : YULEE
State : FL
Zip : 32097-6460
Country : US
Telephone Number : 904-875-4461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2024
Last Update Date : 05/13/2024

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