Provider Demographics
NPI:1225813900
Name:TAYLOR, LAURA KEELY (DAOM, LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KEELY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-0356
Mailing Address - Country:US
Mailing Address - Phone:706-566-6116
Mailing Address - Fax:
Practice Address - Street 1:52980 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:IDYLLWILD-PINE COVE
Practice Address - State:CA
Practice Address - Zip Code:92549
Practice Address - Country:US
Practice Address - Phone:706-566-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist