Provider Demographics
NPI:1114434438
Name:THIELS, ALLISON TAYLOR
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:TAYLOR
Last Name:THIELS
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 1:542 JIM SMITH RD
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-9156
Mailing Address - Country:US
Mailing Address - Phone:859-576-0172
Mailing Address - Fax:
Practice Address - Street 1:1203 AMERICAN GREETING CARD RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4811
Practice Address - Country:US
Practice Address - Phone:606-528-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist