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General NPI Number Information
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NPI Number | 1811660814
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Entity Type | Individual
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Provider Name | MALIK TAIT
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Gender | Male
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 11602 LAKE UNDERHILL RD STE 129
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City | ORLANDO
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State | FL
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Zip | 32825-4460
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Country | US
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Telephone | 407-277-5400
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Fax | 321-281-4959
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Provider Business Mailing Address
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Address Line | 5454 CARAMELLA DR
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City | ORLANDO
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State | FL
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Zip | 32829-8275
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Country | US
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Telephone | 904-729-3281
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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 | FL
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