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NPI Code Detail

MEDICARE: KATELYN LOUIS COVENTRY

MEDICARE: KATELYN LOUIS COVENTRY
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 TechnicianRBT20135515

General Provider Information

NPI Number : 1740897552
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN LOUIS COVENTRY
Provider Business Mailing Address
First Line : 1486 DONEGAL DR
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-6057
Country : US
Telephone Number : 404-405-5113
Fax Number :
Provider Business Practice Location Address
First Line : 2740 N HARBOR CITY BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-6291
Country : US
Telephone Number : 321-622-6884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2020
Last Update Date : 09/25/2020

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Directions to “ KATELYN LOUIS COVENTRY ” Practice Location

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