Provider Demographics
NPI:1205673092
Name:STICKELMEYER, TAYLOR B
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:B
Last Name:STICKELMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22288 E 731 DR
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-6915
Mailing Address - Country:US
Mailing Address - Phone:918-570-2741
Mailing Address - Fax:
Practice Address - Street 1:22288 E 731 DR
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-6915
Practice Address - Country:US
Practice Address - Phone:918-570-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist