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General NPI Number Information
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NPI Number | 1568687077
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Entity Type | Individual
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Provider Name | MRS. DENISE TAYLOR
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4505 WINTERBOURNE DR
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City | PETERSBURG
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State | VA
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Zip | 23803-1724
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Country | US
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Telephone | 804-526-1116
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Fax | 804-526-0023
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Provider Business Mailing Address
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Address Line | 4505 WINTERBOURNE DR
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City | PETERSBURG
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State | VA
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Zip | 23803-1724
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Country | US
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Telephone | 804-526-1116
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Fax | 804-526-0023
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 839-01001
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License Number State | VA
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