Provider Demographics
NPI:1235504739
Name:REEF, TAYLOR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:REEF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IN
Mailing Address - Zip Code:46929-1073
Mailing Address - Country:US
Mailing Address - Phone:765-202-0013
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IN
Practice Address - Zip Code:46929
Practice Address - Country:US
Practice Address - Phone:765-202-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor