Provider Demographics
NPI:1639768047
Name:TAYLOR, ANDREA JOCELYN (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:JOCELYN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 POST RD APT 6210
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7338
Mailing Address - Country:US
Mailing Address - Phone:240-281-6510
Mailing Address - Fax:
Practice Address - Street 1:5700 DACY LN
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-5904
Practice Address - Country:US
Practice Address - Phone:512-268-8508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer