Healthcare Provider Details

I. General information

NPI: 1750875357
Provider Name (Legal Business Name): TAYLOR CHRISTINE KUCHARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N STAEBLER RD
ANN ARBOR MI
48103-9755
US

IV. Provider business mailing address

5572 STANHOPE ST
WEST BLOOMFIELD MI
48322-1220
US

V. Phone/Fax

Practice location:
  • Phone: 248-496-2994
  • Fax:
Mailing address:
  • Phone: 248-496-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: