MEDICARE: TAMILYN D MCCRAY

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1336658426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMILYN D MCCRAY

Provider Business Mailing Address
First Line	:	1121 LOUISIANA AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2850
Country	:	US
Telephone Number	:	850-774-2366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1137 HARRISON AVE STE 13A
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2498
Country	:	US
Telephone Number	:	850-778-2233
Fax Number	:	850-778-2233

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

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	09/21/2017

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