Healthcare Provider Details

I. General information

NPI: 1194488288
Provider Name (Legal Business Name): TAYLOR GM DURLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S FLOYD LN
CHICAGO HEIGHTS IL
60411-1109
US

IV. Provider business mailing address

105 S FLOYD LN
CHICAGO HEIGHTS IL
60411-1109
US

V. Phone/Fax

Practice location:
  • Phone: 708-289-7944
  • Fax:
Mailing address:
  • Phone: 708-289-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1856099
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1856099
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number1856099
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: