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NPI Code Detail

MEDICARE: TAYLA LOUISE PENOVICH BCBA

MEDICARE: TAYLA LOUISE PENOVICH BCBA
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
1103K00000XBehavior AnalystRBT-16-16125FL
2103K00000XBehavior Analyst1-19-38143FL

Other Identifiers

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

General Provider Information

NPI Number : 1720576499
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLA LOUISE PENOVICH BCBA
Provider Business Mailing Address
First Line : 1509 E COLONIAL DR STE 300
Second Line :
City : ORLANDO
State : FL
Zip : 32803-4729
Country : US
Telephone Number : 407-218-4371
Fax Number : 407-218-4304
Provider Business Practice Location Address
First Line : 500 E COLONIAL DR
Second Line :
City : ORLANDO
State : FL
Zip : 32803-4510
Country : US
Telephone Number : 407-218-4340
Fax Number : 407-218-4303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2018
Last Update Date : 12/04/2020

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Directions to “ TAYLA LOUISE PENOVICH BCBA” Practice Location

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