MEDICARE: KAYLA ROBIN TULLOCH

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	:	1538027214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ROBIN TULLOCH

Provider Business Mailing Address
First Line	:	1026 COASTAL CIR
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4321
Country	:	US
Telephone Number	:	516-410-4021
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 S HIAWASSEE RD STE 203
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6317
Country	:	US
Telephone Number	:	407-286-4031
Fax Number	:	407-286-4158

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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