Basic Information
| Provider Information | |||||||||
| NPI: | 1609202407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MT-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 354 PEARL ST | ||||||||
| Address2: | APARTMENT #6 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146073760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853593710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 GROTON PKWY | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146234540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853593710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | 10566 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist |
No ID Information.