Provider Demographics
NPI:1053083337
Name:JEAN, TAYLIN OLIVIA
Entity Type:Individual
Prefix:
First Name:TAYLIN
Middle Name:OLIVIA
Last Name:JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9662
Mailing Address - Country:US
Mailing Address - Phone:919-428-3325
Mailing Address - Fax:
Practice Address - Street 1:1115 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3778
Practice Address - Country:US
Practice Address - Phone:919-428-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer