=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568341568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAKAYLA TAYLOR RANDOLPH BS,HIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2025
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 EARL L CORE RD
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505-5885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-413-0184
-----------------------------------------------------
Fax | 304-413-0185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1425 EARL L CORE RD
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505-5885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 43-413-0184
-----------------------------------------------------
Fax | 304-413-0185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 1144
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------