Provider Demographics
NPI:1629734603
Name:DWYER, TAYLOR ELIZABETH GILLETTE (ATC)
Entity Type:Individual
Prefix:
First Name:TAYLOR ELIZABETH
Middle Name:GILLETTE
Last Name:DWYER
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 1:9717 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND PATENT
Mailing Address - State:NY
Mailing Address - Zip Code:13354-4336
Mailing Address - Country:US
Mailing Address - Phone:518-409-2025
Mailing Address - Fax:
Practice Address - Street 1:357 GENESEE ST STE 2
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2658
Practice Address - Country:US
Practice Address - Phone:518-409-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer