Healthcare Provider Details

I. General information

NPI: 1588595151
Provider Name (Legal Business Name): TAYLOR TER MICHE WIMBREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 21204
TOWSON MD
21204-4763
US

IV. Provider business mailing address

3928 NOYES CIR APT 201
RANDALLSTOWN MD
21133-2305
US

V. Phone/Fax

Practice location:
  • Phone: 240-668-4415
  • Fax:
Mailing address:
  • Phone: 443-413-1278
  • Fax:

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: