Provider Demographics
NPI:1497123095
Name:CARPENTER, TAYLOR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CARPENTER
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 1:625 ALGOMA BLVD
Mailing Address - Street 2:1021
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-3501
Mailing Address - Country:US
Mailing Address - Phone:715-250-2203
Mailing Address - Fax:
Practice Address - Street 1:625 ALGOMA BLVD
Practice Address - Street 2:1021
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3501
Practice Address - Country:US
Practice Address - Phone:715-250-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program