MEDICARE: LATODD TAYLOR

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	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	392068921	OTHER	OK	PRIVATE

General Provider Information

NPI Number	:	1538414297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATODD TAYLOR

Provider Business Mailing Address
First Line	:	8825 OAKRIDGE DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8825 OAKRIDGE DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7417
Country	:	US
Telephone Number	:	480-284-9170
Fax Number	:

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

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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Directions to “ LATODD TAYLOR ” Practice Location

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