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NPI Code Detail

MEDICARE: TAYLOR ROSS MA, BCBA

MEDICARE: TAYLOR ROSS MA, 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
1103K00000XBehavior Analyst7401000719MI

General Provider Information

NPI Number : 1457737231
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR ROSS MA, BCBA
Provider Business Mailing Address
First Line : 44225 W 12 MILE RD STE C-106
Second Line :
City : NOVI
State : MI
Zip : 48377-2640
Country : US
Telephone Number : 248-277-3005
Fax Number :
Provider Business Practice Location Address
First Line : 44225 W 12 MILE RD STE C-106
Second Line :
City : NOVI
State : MI
Zip : 48377-2640
Country : US
Telephone Number : 248-277-3005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2015
Last Update Date : 08/18/2022

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