MEDICARE: TYLA MARIE DUELL

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

General Provider Information

NPI Number	:	1689525537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLA MARIE DUELL

Provider Business Mailing Address
First Line	:	100 N PACIFIC COAST HWY STE 140
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-4359
Country	:	US
Telephone Number	:	310-856-0800
Fax Number	:	310-856-0800

Provider Business Practice Location Address
First Line	:	1455 NW LEARY WAY STE 400
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5138
Country	:	US
Telephone Number	:	206-504-3815
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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