Provider Demographics
NPI:1245791698
Name:TAYLOR, MARIAN DENNISON (LICAC/MAC)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:DENNISON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LICAC/MAC
Other - Prefix:MISS
Other - First Name:MARIAN
Other - Middle Name:DENNISON
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056
Mailing Address - Country:US
Mailing Address - Phone:508-446-7107
Mailing Address - Fax:
Practice Address - Street 1:43 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-446-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist