Provider Demographics
NPI:1740732379
Name:TAYLOR, MARILYN (TRANSPORTATION)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 ROURKE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4827
Mailing Address - Country:US
Mailing Address - Phone:901-309-8627
Mailing Address - Fax:901-309-7712
Practice Address - Street 1:7315 ROURKE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4827
Practice Address - Country:US
Practice Address - Phone:901-309-8627
Practice Address - Fax:901-309-7712
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN065978717171WV0202X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
No172A00000XOther Service ProvidersDriver