Healthcare Provider Details

I. General information

NPI: 1124520721
Provider Name (Legal Business Name): EMILY KATHRYN LAZOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 TEQUESTA DR
TEQUESTA FL
33469-2514
US

IV. Provider business mailing address

426 TEQUESTA DR
TEQUESTA FL
33469-2514
US

V. Phone/Fax

Practice location:
  • Phone: 508-648-0905
  • Fax:
Mailing address:
  • Phone: 508-648-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: