MEDICARE: SWANITA TAYLOR SPECIALIST

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	376J00000X	Homemaker	15099425	TX
2	171M00000X	Case Manager/Care Coordinator	15099425	TX
3	174400000X	Specialist	15099425	TX
4	372500000X	Chore Provider	15099425	TX

General Provider Information

NPI Number	:	1720312952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SWANITA TAYLOR SPECIALIST

Provider Business Mailing Address
First Line	:	2001 LAVERNE ST
Second Line	:	SUITE# 311
City	:	HOUSTON
State	:	TX
Zip	:	77080-6700
Country	:	US
Telephone Number	:	832-267-6386
Fax Number	:	713-647-0501

Provider Business Practice Location Address
First Line	:	8801 HAMMERLY BLVD
Second Line	:	SUITE# 1803
City	:	HOUSTON
State	:	TX
Zip	:	77080-6508
Country	:	US
Telephone Number	:	832-267-6386
Fax Number	:	713-647-0501

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

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	09/22/2009

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