MEDICARE: TAYLOR HENSLEY

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1801270400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR HENSLEY

Provider Business Mailing Address
First Line	:	4940 ARROWVIEW DR
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2557
Country	:	US
Telephone Number	:	937-789-8397
Fax Number	:

Provider Business Practice Location Address
First Line	:	4940 ARROWVIEW DR
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2557
Country	:	US
Telephone Number	:	937-789-8397
Fax Number	:

Authorized Official
Title or Position	:	HEARING SCREEN COORDINATOR
Name	:	TRACY MURRAY
Credential	:
Telephone Number	:	937-208-2534

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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