MEDICARE: KATIE ANN CAROL

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	RBT-21-174487	FL

General Provider Information

NPI Number	:	1871200345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ANN CAROL

Provider Business Mailing Address
First Line	:	864 17TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-4226
Country	:	US
Telephone Number	:	863-273-0483
Fax Number	:

Provider Business Practice Location Address
First Line	:	864 17TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-4226
Country	:	US
Telephone Number	:	863-273-0483
Fax Number	:

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

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	04/17/2023

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Directions to “ KATIE ANN CAROL ” Practice Location

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