Provider Demographics
NPI:1609202407
Name:SMITH, TAYLOR L (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 PEARL ST
Mailing Address - Street 2:APARTMENT #6
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3760
Mailing Address - Country:US
Mailing Address - Phone:585-359-3710
Mailing Address - Fax:
Practice Address - Street 1:100 GROTON PKWY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4540
Practice Address - Country:US
Practice Address - Phone:585-359-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10566225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist