Provider Demographics
NPI:1346948098
Name:ROWE, TAYLOR RENEIGH
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEIGH
Last Name:ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 BIG TYLER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1304
Mailing Address - Country:US
Mailing Address - Phone:304-766-9830
Mailing Address - Fax:
Practice Address - Street 1:5512 BIG TYLER RD STE 300
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1304
Practice Address - Country:US
Practice Address - Phone:304-766-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician