Provider Demographics
NPI:1386480218
Name:TAYLOR, NICOLE (MT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3881 W 2340 S
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:UT
Mailing Address - Zip Code:84401-5902
Mailing Address - Country:US
Mailing Address - Phone:801-896-7211
Mailing Address - Fax:
Practice Address - Street 1:1893 E SKYLINE DR STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5382
Practice Address - Country:US
Practice Address - Phone:801-896-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12733038-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist