Provider Demographics
NPI:1609228691
Name:RUDER, TAYLOR (ATC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:RUDER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 GARVER ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8932
Mailing Address - Country:US
Mailing Address - Phone:513-939-5803
Mailing Address - Fax:
Practice Address - Street 1:5024 GARVER ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-8932
Practice Address - Country:US
Practice Address - Phone:513-939-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTCA4332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer