Healthcare Provider Details

I. General information

NPI: 1841802964
Provider Name (Legal Business Name): TAYLOR ANN TOFTEMARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8282 28TH CT NE STE A
LACEY WA
98516-7162
US

IV. Provider business mailing address

970 21ST AVE
LONGVIEW WA
98632-2226
US

V. Phone/Fax

Practice location:
  • Phone: 360-915-6868
  • Fax:
Mailing address:
  • Phone: 360-957-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: