Healthcare Provider Details

I. General information

NPI: 1275452575
Provider Name (Legal Business Name): MS. LAILA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 DWYER LN
LAKE MARY FL
32746-1809
US

IV. Provider business mailing address

2522 DWYER LN
LAKE MARY FL
32746-1809
US

V. Phone/Fax

Practice location:
  • Phone: 321-948-5706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: