Provider Demographics
NPI:1881127116
Name:GATRELL, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GATRELL
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 1:1631 MARTY DR
Mailing Address - Street 2:
Mailing Address - City:PIERSON
Mailing Address - State:FL
Mailing Address - Zip Code:32180-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1631 MARTY DR
Practice Address - Street 2:
Practice Address - City:PIERSON
Practice Address - State:FL
Practice Address - Zip Code:32180-3104
Practice Address - Country:US
Practice Address - Phone:386-679-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician