Healthcare Provider Details

I. General information

NPI: 1235050683
Provider Name (Legal Business Name): TAYLOR MARIE BAIR I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 9TH AVE S
FORT DODGE IA
50501-5440
US

IV. Provider business mailing address

2520 9TH AVE S
FORT DODGE IA
50501-5440
US

V. Phone/Fax

Practice location:
  • Phone: 515-293-5620
  • Fax: 515-414-7642
Mailing address:
  • Phone: 515-293-5620
  • Fax: 515-414-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: