Provider Demographics
NPI:1811368293
Name:TAYLOR, CHELISA (CBCS)
Entity type:Individual
Prefix:MS
First Name:CHELISA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CBCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 EMERITUS CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2216
Mailing Address - Country:US
Mailing Address - Phone:702-202-0099
Mailing Address - Fax:702-778-7632
Practice Address - Street 1:2120 SOUTH JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-202-0099
Practice Address - Fax:702-778-7632
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVL7H7Y5F8225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner