Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1801083217 |
---|---|
Provider Name | Mark E Taylor |
First Address | Auburn, CA 95603-2854 |
Second Address | Auburn, CA 95603-2854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2007 |
Last Update Date | 29/09/2007 |