1386048007 NPI number — MICHELLE MARY KEANE-TAYLOR COTA/L

Table of content: MICHELLE MARY KEANE-TAYLOR COTA/L (NPI 1386048007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386048007 NPI number — MICHELLE MARY KEANE-TAYLOR COTA/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEANE-TAYLOR
Provider First Name:
MICHELLE
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COTA/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386048007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 PROSPECT HTS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD SPRINGS
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06076-1112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-573-7017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1157 ENFIELD STREET
Provider Second Line Business Practice Location Address:
KINDRED HEALTHCARE @ PARKWAY PAVILION
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-745-1641
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  000568 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 224Z00000X , with the licence number: 2808 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com