MEDICARE: ALESHA RENE' 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1578000485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALESHA RENE' TAYLOR

Provider Business Mailing Address
First Line	:	401 S WASHINGTON SQ UNIT 304
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-2148
Country	:	US
Telephone Number	:	616-427-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S WASHINGTON SQ UNIT 304
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-2148
Country	:	US
Telephone Number	:	616-427-6816
Fax Number	:

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

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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Directions to “ ALESHA RENE' TAYLOR ” Practice Location

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