Provider Demographics
NPI:1497170054
Name:FERRELL, TAYLOR (LMT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FERRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 E PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5986
Mailing Address - Country:US
Mailing Address - Phone:419-202-6066
Mailing Address - Fax:
Practice Address - Street 1:2500 W STRUB RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5390
Practice Address - Country:US
Practice Address - Phone:419-626-4162
Practice Address - Fax:419-262-1268
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPE046052225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist