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NPI Code Detail

MEDICARE: MRS. LAURA TWILLEY

MEDICARE: MRS. LAURA TWILLEY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1184197675
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA TWILLEY
Provider Business Mailing Address
First Line : 175 MIDDLE ST UNIT 1201
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-3625
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 12725 RACE TRACK RD BLDG 5
Second Line :
City : WESTCHASE
State : FL
Zip : 33626-1314
Country : US
Telephone Number : 866-610-0580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2019
Last Update Date : 01/07/2019

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