Provider Demographics
NPI:1114644788
Name:TERWILLIGER, TAYLOR FUREY
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:FUREY
Last Name:TERWILLIGER
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 1:1432 ADDISON BACK RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:NY
Mailing Address - Zip Code:14801-9338
Mailing Address - Country:US
Mailing Address - Phone:607-329-1476
Mailing Address - Fax:
Practice Address - Street 1:1432 ADDISON BACK RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:NY
Practice Address - Zip Code:14801-9338
Practice Address - Country:US
Practice Address - Phone:607-329-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer