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NPI Code Detail

MEDICARE: TAYLOR KETELAAR

MEDICARE: TAYLOR KETELAAR
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
1103K00000XBehavior Analyst
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1235811316
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR KETELAAR
Provider Business Mailing Address
First Line : 9305 GARDEN GATE DR NE
Second Line :
City : ROCKFORD
State : MI
Zip : 49341-7969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : PO BOX 392
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-0392
Country : US
Telephone Number : 231-268-0007
Fax Number : 231-525-3170
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2023
Last Update Date : 05/12/2025

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Directions to “ TAYLOR KETELAAR ” Practice Location

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