Healthcare Provider Details

I. General information

NPI: 1003926403
Provider Name (Legal Business Name): PATRICIA KAY TAYLOR MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA B. TAYLOR MS, RD, LD

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-8608
US

IV. Provider business mailing address

14205 CLARKSBURG PIKE
NEW HOLLAND OH
43145-9722
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax: 740-772-7132
Mailing address:
  • Phone: 740-495-5173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1682
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: