Provider Demographics
NPI:1952770794
Name:TAYLOR, MARLIN (COTA)
Entity Type:Individual
Prefix:
First Name:MARLIN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 HIGHWAY 365
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MAYFLOWER
Mailing Address - State:AR
Mailing Address - Zip Code:72106-9524
Mailing Address - Country:US
Mailing Address - Phone:501-470-3500
Mailing Address - Fax:
Practice Address - Street 1:582 HIGHWAY 365
Practice Address - Street 2:SUITE 3
Practice Address - City:MAYFLOWER
Practice Address - State:AR
Practice Address - Zip Code:72106-9524
Practice Address - Country:US
Practice Address - Phone:501-470-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A911174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator