Healthcare Provider Details

I. General information

NPI: 1437746344
Provider Name (Legal Business Name): TAYLOR THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2020
Last Update Date: 12/26/2020
Certification Date: 12/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 AVENUE O NE
WINTER HAVEN FL
33881-2409
US

IV. Provider business mailing address

1417 SHADY LANE DR
ORLANDO FL
32804-6137
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-3103
  • Fax:
Mailing address:
  • Phone: 407-982-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: