Healthcare Provider Details

I. General information

NPI: 1285031369
Provider Name (Legal Business Name): LAURA TAYLOR LMT, CMLDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9019 W BELDING RD STE 4
BELDING MI
48809-9280
US

IV. Provider business mailing address

9019 W BELDING RD STE 4
BELDING MI
48809-9280
US

V. Phone/Fax

Practice location:
  • Phone: 616-717-2313
  • Fax: 616-469-1170
Mailing address:
  • Phone: 616-717-2313
  • Fax: 616-469-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501000091
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: