Provider Demographics
NPI:1063193340
Name:TAYLOR, CONSTANCE MAY
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 HIGHWAY 31 E STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-9220
Mailing Address - Country:US
Mailing Address - Phone:812-590-3800
Mailing Address - Fax:812-203-5987
Practice Address - Street 1:4755 HIGHWAY 31 E STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-9220
Practice Address - Country:US
Practice Address - Phone:812-590-3800
Practice Address - Fax:812-203-5678
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21404974225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist