MEDICARE: MS. CHICOLA L TAYLOR LMT

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	18KT01456800	NJ

General Provider Information

NPI Number	:	1710797428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHICOLA L TAYLOR LMT

Provider Business Mailing Address
First Line	:	47 WOODSTOWN RD
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062-9635
Country	:	US
Telephone Number	:	856-490-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 WOODSTOWN RD
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062-9635
Country	:	US
Telephone Number	:	856-490-3174
Fax Number	:

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

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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