Individual
LARYSSA ANN TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4738 SHETLAND CT SE, SALEM, OR 97317-6070
(971) 718-0515
Mailing address
4738 SHETLAND CT SE, SALEM, OR 97317-6070
(971) 718-0515
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BV83276D
—
OR
Enumeration date
07/24/2018
Last updated
07/24/2018
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