Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA011605 | OH |
NPI | 1003493255 |
---|---|
Provider Name | Kayla Dawn Taggart |
First Address | Centerville, OH 45459-2284 |
Second Address | Xenia, OH 45385-1281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2021 |
Last Update Date | 25/03/2021 |