=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265308969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA TAYLER GOLD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2025
-----------------------------------------------------
Last Update Date | 10/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 COMMONS WAY
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-1908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-210-0336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 592
-----------------------------------------------------
City | COLUMBIA FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59912-0592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-210-0336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | LMT-LMT-LIC-30985
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------