Provider Demographics
NPI:1114708104
Name:RODRIGUEZ, KATELYN CHASTITY
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:CHASTITY
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 TALON CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4515
Mailing Address - Country:US
Mailing Address - Phone:407-780-0068
Mailing Address - Fax:
Practice Address - Street 1:13538 VILLAGE PARK DR STE 145
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-3600
Practice Address - Country:US
Practice Address - Phone:407-730-2948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician