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General NPI Number Information
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NPI Number | 1558015230
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Entity Type | Individual
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Provider Name | TAYLOR VICKERY
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Gender | Female
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 3790 DAIRY RD STE 108
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City | MELBOURNE
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State | FL
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Zip | 32904-7630
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Country | US
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Telephone | 813-219-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 4555 BONANZA ST
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City | COCOA
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State | FL
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Zip | 32927-3613
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Country | US
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Telephone | 321-298-3819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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