Provider Demographics
NPI:1528313590
Name:TAYLOR, MICHI N
Entity type:Individual
Prefix:
First Name:MICHI
Middle Name:N
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 1:6500 W CHARLESTON BLVD APT 84
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9067
Mailing Address - Country:US
Mailing Address - Phone:702-712-5721
Mailing Address - Fax:
Practice Address - Street 1:6500 W CHARLESTON BLVD APT 84
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9067
Practice Address - Country:US
Practice Address - Phone:702-712-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner