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NPI Code Detail

MEDICARE: ROBERTA HARRELL TAYLOR

MEDICARE: ROBERTA HARRELL 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
1225200000XPhysical Therapy Assistant1742NC

General Provider Information

NPI Number : 1952541146
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA HARRELL TAYLOR
Provider Business Mailing Address
First Line : PO BOX 831
Second Line :
City : MADILL
State : OK
Zip : 73446-0831
Country : US
Telephone Number : 580-795-3301
Fax Number : 580-795-7307
Provider Business Practice Location Address
First Line : 306 DEER PARK RD
Second Line :
City : NEBO
State : NC
Zip : 28761-8746
Country : US
Telephone Number : 580-795-3301
Fax Number : 580-795-7307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2009
Last Update Date : 02/27/2009

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