Provider Demographics
NPI:1003698879
Name:SCIURY, TAYLOR RENEE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:SCIURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:RENEE
Other - Last Name:ODOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 N. MILLER ROAD
Mailing Address - Street 2:SUITE 150A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3713
Mailing Address - Country:US
Mailing Address - Phone:300-867-2240
Mailing Address - Fax:330-630-3198
Practice Address - Street 1:105 EXECUTIVE PARKWAY, SUITE 100
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1692
Practice Address - Country:US
Practice Address - Phone:330-655-0946
Practice Address - Fax:330-630-3198
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000767374103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst