Provider Demographics
NPI:1588027916
Name:TAYLOR, ANNA MARIE (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 TAUSICK WAY
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-9270
Mailing Address - Country:US
Mailing Address - Phone:509-527-1860
Mailing Address - Fax:509-527-4321
Practice Address - Street 1:500 TAUSICK WAY
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-9270
Practice Address - Country:US
Practice Address - Phone:509-527-1860
Practice Address - Fax:509-527-4321
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1601966402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer