Provider Demographics
NPI:1740506757
Name:TAYLOR, KYLEE JO (MT)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:JO
Last Name:TAYLOR
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:PO BOX 1412
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-1412
Mailing Address - Country:US
Mailing Address - Phone:303-838-0990
Mailing Address - Fax:
Practice Address - Street 1:26291 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433
Practice Address - Country:US
Practice Address - Phone:303-838-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6389225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist