=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063087971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAYLOR SCOTT RBT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2021
-----------------------------------------------------
Last Update Date | 05/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6816 SOUTHPOINT PKWY STE 500
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-538-0713
-----------------------------------------------------
Fax | 904-538-0714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10175 FORTUNE PKWY UNIT 903
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-6755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-538-0713
-----------------------------------------------------
Fax | 904-538-0714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 21-167666
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------