Provider Demographics
NPI:1760921852
Name:WHITTER, TAYLOR JEAN (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:JEAN
Last Name:WHITTER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JEAN
Other - Last Name:ASHCRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 STONE LN APT 5246
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 BOYDEN BUILDING
Practice Address - Street 2:131 COMMONWEALTH AVENUE
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003
Practice Address - Country:US
Practice Address - Phone:719-209-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2000217462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer