MEDICARE: INDEPENDENT LIVING INC.

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
2	103K00000X	Behavior Analyst
3	106E00000X	Assistant Behavior Analyst
4	106S00000X	Behavior Technician
5	225100000X	Physical Therapist
6	225X00000X	Occupational Therapist	OT4289	FL
7	225X00000X	Occupational Therapist
8	261Q00000X	Clinic/Center
9	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124072947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT LIVING INC.

Provider Business Mailing Address
First Line	:	6508 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4022
Country	:	US
Telephone Number	:	813-963-6923
Fax Number	:	813-264-0768

Provider Business Practice Location Address
First Line	:	6508 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4022
Country	:	US
Telephone Number	:	813-963-6923
Fax Number	:	813-264-0768

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARRIE GOTFRIED GUISE
Credential	:
Telephone Number	:	813-963-6923

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/24/2023

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Directions to “INDEPENDENT LIVING INC. ” Practice Location

Language	Start Address	Practice Location

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