MEDICARE: BRITTANY THAXTON

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	235Z00000X	Speech-Language Pathologist	024611	NY

General Provider Information

NPI Number	:	1619335114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY THAXTON

Provider Business Mailing Address
First Line	:	200 WATER ST
Second Line	:	APT 2502
City	:	NEW YORK
State	:	NY
Zip	:	10038-3558
Country	:	US
Telephone Number	:	832-515-9511
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WATER ST
Second Line	:	APT 2502
City	:	NEW YORK
State	:	NY
Zip	:	10038-3558
Country	:	US
Telephone Number	:	832-515-9511
Fax Number	:

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

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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Directions to “ BRITTANY THAXTON ” Practice Location

Language	Start Address	Practice Location

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