Healthcare Provider Details

I. General information

NPI: 1407767528
Provider Name (Legal Business Name): TAYLOR NICOLE CHURCHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 HERITAGE CT SW STE 200
OLYMPIA WA
98502-6046
US

IV. Provider business mailing address

PO BOX 6286
OLYMPIA WA
98507-6286
US

V. Phone/Fax

Practice location:
  • Phone: 360-810-2276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB70136275
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: