Provider Demographics
NPI:1801083217
Name:TAYLOR, MARK E
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 GRASS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2854
Mailing Address - Country:US
Mailing Address - Phone:530-823-3143
Mailing Address - Fax:
Practice Address - Street 1:1755 GRASS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2854
Practice Address - Country:US
Practice Address - Phone:530-823-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter