MEDICARE: TAYLOR WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1073052031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR WILSON

Provider Business Mailing Address
First Line	:	PO BOX 58948
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70158-8948
Country	:	US
Telephone Number	:	985-855-2239
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 FRANKLIN AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6009
Country	:	US
Telephone Number	:	985-855-2239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	02/22/2017

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Directions to “ TAYLOR WILSON ” Practice Location

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