Provider Demographics
NPI:1841800737
Name:TICE, TAYLOR ANNE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANNE
Last Name:TICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANNE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13576 DEN HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5545
Mailing Address - Country:US
Mailing Address - Phone:610-392-7636
Mailing Address - Fax:
Practice Address - Street 1:11 HOPE RD STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7287
Practice Address - Country:US
Practice Address - Phone:540-225-1020
Practice Address - Fax:540-205-6939
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care