Healthcare Provider Details

I. General information

NPI: 1396550281
Provider Name (Legal Business Name): TAYLOR COTY LINEBACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 10TH AVE
SIDNEY NE
69162-1609
US

IV. Provider business mailing address

918 SHELDON STREET
LODGEPOLE NE
69149
US

V. Phone/Fax

Practice location:
  • Phone: 308-249-0718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: