Provider Demographics
NPI:1508217522
Name:TAYLOR, ASHLIE (LMT)
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:
Last Name:TAYLOR
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 1:18 FENWICK ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2430
Mailing Address - Country:US
Mailing Address - Phone:617-863-2545
Mailing Address - Fax:
Practice Address - Street 1:18 FENWICK ST
Practice Address - Street 2:APT 2
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2430
Practice Address - Country:US
Practice Address - Phone:617-863-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13460225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist