Healthcare Provider Details

I. General information

NPI: 1609413806
Provider Name (Legal Business Name): TAYLOR MAXWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10327 W 84TH TER
LENEXA KS
66214-1639
US

IV. Provider business mailing address

924 W 6TH ST
JUNCTION CITY KS
66441-3229
US

V. Phone/Fax

Practice location:
  • Phone: 785-256-9096
  • Fax:
Mailing address:
  • Phone: 785-256-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: