Provider Demographics
NPI:1144737594
Name:HOEKWATER, TAYLOR (MSA, AT, ATC, EMT-B)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:HOEKWATER
Suffix:
Gender:F
Credentials:MSA, AT, ATC, EMT-B
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MAYLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSA, AT, ATC, EMT-B
Mailing Address - Street 1:501 S LANSING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL MICHIGAN UNIVERSITY HEALTH PROFESSIONS OFC 1205
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-0001
Practice Address - Country:US
Practice Address - Phone:989-774-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3203054300146N00000X
MI26010014112081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic