Ethan Wade Taylor
NPI #1841636115 in Tishomingo, Oklahoma
Provider Information
- NPI Number
- 1841636115
- Entity Type
- Individual
- Name
- Ethan Wade Taylor
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Case Manager/Care Coordinator
- Enumeration Date
- May 14, 2013
- Last Updated
- May 14, 2013
Practice Location
- Address
- 1350 S MULDROW ST
- City
- Tishomingo
- State
- Oklahoma
- ZIP Code
- 73460-3278
- Phone
- (830) 928-6990
Specialties & Taxonomy Codes
| Specialty |
|---|
| Case Manager/Care Coordinator |
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