Provider Demographics
NPI:1841055563
Name:DATTILO, TAYLOR M
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:DATTILO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2065 MATTERN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1911
Mailing Address - Country:US
Mailing Address - Phone:806-544-5553
Mailing Address - Fax:
Practice Address - Street 1:2065 MATTERN DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1911
Practice Address - Country:US
Practice Address - Phone:806-544-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program