MEDICARE: KAYLA MORTARA

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		FL

General Provider Information

NPI Number	:	1932647500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MORTARA

Provider Business Mailing Address
First Line	:	2389 OAK MYRTLE LN
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6328
Country	:	US
Telephone Number	:	813-862-3030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2389 OAK MYRTLE LN
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6328
Country	:	US
Telephone Number	:	813-862-3030
Fax Number	:

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

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/26/2025

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Directions to “ KAYLA MORTARA ” Practice Location

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