Provider Demographics
NPI:1285031369
Name:TAYLOR, LAURA (LMT, CMLDT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9019 W BELDING RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-9280
Mailing Address - Country:US
Mailing Address - Phone:616-717-2313
Mailing Address - Fax:616-469-1170
Practice Address - Street 1:9019 W BELDING RD STE 4
Practice Address - Street 2:
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-9280
Practice Address - Country:US
Practice Address - Phone:616-717-2313
Practice Address - Fax:616-469-1170
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501000091OtherMASSAGE THERAPIST LICENSE