Provider Demographics
NPI:1831436377
Name:CHADWELL, TAYLOR RAE
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:RAE
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:RAE
Other - Last Name:SPYRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 S J T STITES BLVD
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-9323
Mailing Address - Country:US
Mailing Address - Phone:918-775-7787
Mailing Address - Fax:
Practice Address - Street 1:205 S J T STITES BLVD
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9323
Practice Address - Country:US
Practice Address - Phone:918-775-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health