Healthcare Provider Details

I. General information

NPI: 1609090406
Provider Name (Legal Business Name): JOHN CAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST
SACO ME
04072-1556
US

IV. Provider business mailing address

301 MAIN ST
SACO ME
04072-1556
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-5493
  • Fax:
Mailing address:
  • Phone: 207-282-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAP100
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: