Healthcare Provider Details

I. General information

NPI: 1225309776
Provider Name (Legal Business Name): TAYLORE GRYMONNT LIC. ACUP.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2012
Last Update Date: 01/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SPRING ST SUITE 2
MONTPELIER VT
05602-2259
US

IV. Provider business mailing address

3 SPRING ST SUITE 2
MONTPELIER VT
05602-2259
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-0303
  • Fax:
Mailing address:
  • Phone: 802-223-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091-0000067
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: