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NPI Code Detail

MEDICARE: TABBITHA LILLY

MEDICARE:   TABBITHA  LILLY
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
1106S00000XBehavior TechnicianRBT-21-168045FL

General Provider Information

NPI Number : 1871167619
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABBITHA LILLY
Provider Business Mailing Address
First Line : 8317 FRONT BEACH RD STE 23
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32407-4893
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 850 N TYNDALL PKWY
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-9407
Country : US
Telephone Number : 850-691-2559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2021
Last Update Date : 09/16/2024

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Directions to “ TABBITHA LILLY ” Practice Location

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