Provider Demographics
NPI:1073261087
Name:TAYLOR, TAMMY L
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:TAYLOR
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 1:115 TOWNSHIP ROAD 1111
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-8436
Mailing Address - Country:US
Mailing Address - Phone:681-378-9483
Mailing Address - Fax:
Practice Address - Street 1:27 PRIVATE DRIVE 8700 UNIT 6
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-7882
Practice Address - Country:US
Practice Address - Phone:740-861-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty