MEDICARE: DONETTA TAYLOR

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	374U00000X	Home Health Aide	400103800402	OH

General Provider Information

NPI Number	:	1922419225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONETTA TAYLOR

Provider Business Mailing Address
First Line	:	5608 WATERBURY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3507
Country	:	US
Telephone Number	:	216-527-3171
Fax Number	:

Provider Business Practice Location Address
First Line	:	5608 WATERBURY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3507
Country	:	US
Telephone Number	:	216-527-3171
Fax Number	:

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

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	05/08/2014

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