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NPI Code Detail

MEDICARE: KELLY PECORA

MEDICARE: KELLY PECORA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1316487051
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY PECORA
Provider Business Mailing Address
First Line : 1466 WESTBURY DR
Second Line :
City : CLERMONT
State : FL
Zip : 34711-7137
Country : US
Telephone Number : 724-713-2133
Fax Number :
Provider Business Practice Location Address
First Line : 17335 PAGONIA DR STE 109
Second Line :
City : CLERMONT
State : FL
Zip : 34711-6011
Country : US
Telephone Number : 407-614-4299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2017
Last Update Date : 03/01/2017

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Directions to “ KELLY PECORA ” Practice Location

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