MEDICARE: LYDIA J TAYLOR

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	373H00000X	Day Training/Habilitation Specialist
2	372600000X	Adult Companion

General Provider Information

NPI Number	:	1790487973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA J TAYLOR

Provider Business Mailing Address
First Line	:	843 HARMONY HILLS LOOP
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2719
Country	:	US
Telephone Number	:	863-617-3743
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 E PINE ST STE 1204
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4969
Country	:	US
Telephone Number	:	863-617-3743
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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