Provider Demographics
NPI:1023516168
Name:TAYLOR, NICKOLAS JOHN (BLA, ATS)
Entity type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:JOHN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:BLA, ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E FRONT ST APT 105
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-4867
Mailing Address - Country:US
Mailing Address - Phone:231-578-5796
Mailing Address - Fax:
Practice Address - Street 1:119 E FRONT ST APT 105
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4867
Practice Address - Country:US
Practice Address - Phone:231-578-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer