Provider Demographics
NPI:1225567936
Name:EDWARDS, TAYLOR (DT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 MEREDITH DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-8180
Mailing Address - Country:US
Mailing Address - Phone:217-891-2772
Mailing Address - Fax:
Practice Address - Street 1:485 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-8180
Practice Address - Country:US
Practice Address - Phone:217-891-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist