Provider Demographics
NPI:1003447608
Name:WEBBER, KATELYN KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:KATHLEEN
Last Name:WEBBER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATELYN
Other - Middle Name:KATHLEEN
Other - Last Name:WEBBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KATELYN COOK
Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:
Practice Address - Street 1:5454 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-2853
Practice Address - Country:US
Practice Address - Phone:866-610-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician