Provider Demographics
NPI:1235947862
Name:PURDY, TAYLOR A
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:PURDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9366
Mailing Address - Country:US
Mailing Address - Phone:740-501-6621
Mailing Address - Fax:
Practice Address - Street 1:8391 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9366
Practice Address - Country:US
Practice Address - Phone:740-501-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care