MEDICARE: KYLIE ROWAN RIDER

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		FL

General Provider Information

NPI Number	:	1316887581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE ROWAN RIDER

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	882-022-4702
Fax Number	:

Provider Business Practice Location Address
First Line	:	17335 PAGONIA RD STE 109
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6011
Country	:	US
Telephone Number	:	882-022-4702
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	04/09/2026

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Directions to “ KYLIE ROWAN RIDER ” Practice Location

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