Healthcare Provider Details

I. General information

NPI: 1841103348
Provider Name (Legal Business Name): ORVILLE TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 NEW HAVEN AVE
MILFORD CT
06460-3663
US

IV. Provider business mailing address

865 NEW HAVEN AVE
MILFORD CT
06460-3663
US

V. Phone/Fax

Practice location:
  • Phone: 347-680-4804
  • Fax:
Mailing address:
  • Phone: 347-680-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number10.240486
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: