Individual
SAMUEL ALEXANDER GAITAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 N CENTRAL AVE STE 110, KISSIMMEE, FL 34741-4439
(407) 925-5623
Mailing address
1200 N CENTRAL AVE STE 110, KISSIMMEE, FL 34741-4439
(407) 925-5623
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
—
—
2355S0801X
Speech-Language Assistant
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
06/30/2020
Last updated
05/16/2022
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