MEDICARE: MRS. STEPHANIE MORGAN TAYLOR L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	227013125	IL

General Provider Information

NPI Number	:	1013315829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE MORGAN TAYLOR L.M.T.

Provider Business Mailing Address
First Line	:	411 SOUTH RD
Second Line	:
City	:	CAMBRIDGE
State	:	IL
Zip	:	61238-1402
Country	:	US
Telephone Number	:	309-714-8870
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 SOUTH RD
Second Line	:
City	:	CAMBRIDGE
State	:	IL
Zip	:	61238-1402
Country	:	US
Telephone Number	:	309-714-8870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/10/2014

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