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General NPI Number Information
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NPI Number | 1902428899
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Entity Type | Individual
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Provider Name | TAYLOR LORRAINE FOWLER RBT
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 7381 114TH AVE, SUITE 405 LARGO FL 33773 SUITE 405
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City | ST. PETERSBURG
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State | FL
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Zip | 33713
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Country | US
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Telephone | 727-258-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 2944 9TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33713-6734
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Country | US
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Telephone | 727-742-5085
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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 | RBT-20-117422
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License Number State | FL
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