Provider Demographics
NPI:1902428899
Name:FOWLER, TAYLOR LORRAINE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:LORRAINE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6734
Mailing Address - Country:US
Mailing Address - Phone:727-742-5085
Mailing Address - Fax:
Practice Address - Street 1:7381 114TH AVE, SUITE 405 LARGO FL 33773
Practice Address - Street 2:SUITE 405
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713
Practice Address - Country:US
Practice Address - Phone:727-258-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117422106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician