Healthcare Provider Details

I. General information

NPI: 1164184651
Provider Name (Legal Business Name): KURTIS ROBERT TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 DOUGLAS RD
TOLEDO OH
43613-2038
US

IV. Provider business mailing address

1035 N HOLLAND SYLVANIA RD APT 6
TOLEDO OH
43615-4394
US

V. Phone/Fax

Practice location:
  • Phone: 503-206-8856
  • Fax:
Mailing address:
  • Phone: 419-276-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: