=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831466267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH T TAYLOR LAYMAN LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2011
-----------------------------------------------------
Last Update Date | 11/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3027 HWY 83 LAZY PINE MALL
-----------------------------------------------------
City | SEELEY LAKE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-677-7722
-----------------------------------------------------
Fax | 406-677-7723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 ALDER LANE
-----------------------------------------------------
City | SEELEY LAKE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59868-0194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-210-2887
-----------------------------------------------------
Fax | 406-677-7723
-----------------------------------------------------
=====================================================
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 | 1328
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------