Provider Demographics
NPI:1083864342
Name:TAYLOR, SEAN PAUL (CERTIFIED PROSTETIST)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CERTIFIED PROSTETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 GOLD DUST ST NE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-9157
Mailing Address - Country:US
Mailing Address - Phone:616-490-8564
Mailing Address - Fax:
Practice Address - Street 1:3318 GOLD DUST ST NE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-9157
Practice Address - Country:US
Practice Address - Phone:616-490-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECP003634332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment