Healthcare Provider Details

I. General information

NPI: 1568920536
Provider Name (Legal Business Name): TAYLIR MAE WILLS RBAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 NW OAK PL
REDMOND OR
97756-1083
US

IV. Provider business mailing address

944 NW OAK PL
REDMOND OR
97756-1083
US

V. Phone/Fax

Practice location:
  • Phone: 541-639-6251
  • Fax:
Mailing address:
  • Phone: 541-639-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: