Provider Demographics
NPI:1063011211
Name:BEARDSALL, TAYLOR (ATR-BC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BEARDSALL
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21220 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-4000
Mailing Address - Country:US
Mailing Address - Phone:248-227-3029
Mailing Address - Fax:
Practice Address - Street 1:21220 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-4000
Practice Address - Country:US
Practice Address - Phone:248-227-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist