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General NPI Number Information
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NPI Number | 1639768047
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Entity Type | Individual
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Provider Name | ANDREA JOCELYN TAYLOR LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 5700 DACY LN
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City | BUDA
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State | TX
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Zip | 78610-5904
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Country | US
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Telephone | 512-268-8508
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Fax |
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Provider Business Mailing Address
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Address Line | 1647 POST RD APT 6210
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City | SAN MARCOS
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State | TX
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Zip | 78666-7338
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Country | US
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Telephone | 240-281-6510
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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 |
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License Number State |
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