MEDICARE: DECORIYANNA GARRETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist	201213178	KY

General Provider Information

NPI Number	:	1073452926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DECORIYANNA GARRETT

Provider Business Mailing Address
First Line	:	1038 S 17TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-2459
Country	:	US
Telephone Number	:	502-953-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1038 S 17TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-2459
Country	:	US
Telephone Number	:	502-953-3399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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