Provider Demographics
NPI:1588469704
Name:BLAKE, TAYLOR MARIE (RD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:SCHAAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1872 ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1872 ARBOR AVE
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-3702
Practice Address - Country:US
Practice Address - Phone:808-278-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered