Provider Demographics
NPI:1821780768
Name:TAYLOR MARTIN, RACHEL LEAH (LPAT 10-26-2015)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEAH
Last Name:TAYLOR MARTIN
Suffix:
Gender:F
Credentials:LPAT 10-26-2015
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:TAYLOR MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8011 NEW LA GRANGE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4781
Mailing Address - Country:US
Mailing Address - Phone:502-744-7490
Mailing Address - Fax:
Practice Address - Street 1:8011 NEW LA GRANGE RD STE 7
Practice Address - Street 2:
Practice Address - City:LYNDON
Practice Address - State:KY
Practice Address - Zip Code:40222-4781
Practice Address - Country:US
Practice Address - Phone:502-744-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166620221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist