Provider Demographics
NPI:1104553189
Name:TAYLOR, KATHERINE E
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
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 1:40 WENDOVER LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-4113
Mailing Address - Country:US
Mailing Address - Phone:904-415-2257
Mailing Address - Fax:
Practice Address - Street 1:40 WENDOVER LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-4113
Practice Address - Country:US
Practice Address - Phone:904-415-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician