MEDICARE: TYLER ALYSSA TAUFER BCBA

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	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1902456056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER ALYSSA TAUFER BCBA

Provider Business Mailing Address
First Line	:	2451B US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3397
Country	:	US
Telephone Number	:	912-312-7409
Fax Number	:	912-525-0377

Provider Business Practice Location Address
First Line	:	2451B US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3397
Country	:	US
Telephone Number	:	912-312-7409
Fax Number	:	912-525-0377

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	05/15/2023

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