Provider Demographics
NPI:1528776796
Name:GOTTFRIED, KATELYNN OLIVIA
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:OLIVIA
Last Name:GOTTFRIED
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 1:110 HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7268
Mailing Address - Country:US
Mailing Address - Phone:336-255-7297
Mailing Address - Fax:
Practice Address - Street 1:110 HIDDEN CREEK DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-7268
Practice Address - Country:US
Practice Address - Phone:336-255-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician