Provider Demographics
NPI:1720449317
Name:ELLER, TAYLINN (MT)
Entity Type:Individual
Prefix:
First Name:TAYLINN
Middle Name:
Last Name:ELLER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 HERITAGE PL
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5251
Mailing Address - Country:US
Mailing Address - Phone:507-332-0202
Mailing Address - Fax:507-332-2206
Practice Address - Street 1:328 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5251
Practice Address - Country:US
Practice Address - Phone:507-332-0202
Practice Address - Fax:507-332-2206
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist