Provider Demographics
NPI:1376892083
Name:TAYLOR, MOLLY J (ATC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3963
Mailing Address - Country:US
Mailing Address - Phone:802-770-9485
Mailing Address - Fax:
Practice Address - Street 1:61 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-9708
Practice Address - Country:US
Practice Address - Phone:802-434-8495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.00885902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer