Provider Demographics
NPI:1619169059
Name:TAYLOR, MARY JO (SPECIALIZED FOSTER)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:SPECIALIZED FOSTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE #1 BOX #17
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:OK
Mailing Address - Zip Code:74869-9701
Mailing Address - Country:US
Mailing Address - Phone:918-866-2532
Mailing Address - Fax:
Practice Address - Street 1:ROUTE #1
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:OK
Practice Address - Zip Code:74869-9701
Practice Address - Country:US
Practice Address - Phone:918-866-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker