MEDICARE: TAYLOR CRANE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-75553	OH

General Provider Information

NPI Number	:	1073349064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR CRANE BCBA

Provider Business Mailing Address
First Line	:	8170 SOUTH AVE STE 7
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6434
Country	:	US
Telephone Number	:	330-977-7268
Fax Number	:	724-965-1475

Provider Business Practice Location Address
First Line	:	8170 SOUTH AVE STE 7
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6434
Country	:	US
Telephone Number	:	330-977-7268
Fax Number	:	724-965-1475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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