MEDICARE: IRIE 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	225700000X	Massage Therapist	7501015243	MI

General Provider Information

NPI Number	:	1831971795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIE TAYLOR

Provider Business Mailing Address
First Line	:	10123 HUFF RD
Second Line	:
City	:	BELLEVUE
State	:	MI
Zip	:	49021-9621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 LANSING ST
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1605
Country	:	US
Telephone Number	:	517-543-1115
Fax Number	:

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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Directions to “ IRIE TAYLOR ” Practice Location

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