Provider Demographics
NPI:1316472491
Name:TAYLOR, STEPHEN PAUL
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 DERBE CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9464
Mailing Address - Country:US
Mailing Address - Phone:217-898-0050
Mailing Address - Fax:
Practice Address - Street 1:7356 E COUNTY ROAD 50 S
Practice Address - Street 2:
Practice Address - City:DUGGER
Practice Address - State:IN
Practice Address - Zip Code:47848
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer