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General NPI Number Information
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NPI Number | 1033546114
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Entity Type | Individual
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Provider Name | NAOMI COLLEEN TAYLOR ATC, PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1111 BAKER AVE
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City | WHITEFISH
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State | MT
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Zip | 59937-2901
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Country | US
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Telephone | 406-862-2515
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Fax |
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Provider Business Mailing Address
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Address Line | 145 LEISURE DR
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City | KALISPELL
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State | MT
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Zip | 59901-8997
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Country | US
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Telephone | 406-212-0299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATR-LAT-LIC-52
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MED-PAC-LIC-60482
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License Number State | MT
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