MEDICARE: HEATHER LAYTON

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	RBT-20-146681	GA

General Provider Information

NPI Number	:	1194313742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LAYTON

Provider Business Mailing Address
First Line	:	PO BOX 631278
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-1278
Country	:	US
Telephone Number	:	800-356-4049
Fax Number	:	941-485-0519

Provider Business Practice Location Address
First Line	:	2550 TRADE CENTER DR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-6167
Country	:	US
Telephone Number	:	800-356-4049
Fax Number	:	941-485-0519

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

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	08/10/2022

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Directions to “ HEATHER LAYTON ” Practice Location

Language	Start Address	Practice Location

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