Healthcare Provider Details

I. General information

NPI: 1740853613
Provider Name (Legal Business Name): DR. TAYLOR ELIZABETH BOBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18115 N US HIGHWAY 41 STE 800
LUTZ FL
33549-6475
US

IV. Provider business mailing address

31722 PASCO RD
SAN ANTONIO FL
33576-8088
US

V. Phone/Fax

Practice location:
  • Phone: 813-848-0341
  • Fax:
Mailing address:
  • Phone: 813-838-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT22085
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number22085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: