Provider Demographics
NPI:1053026690
Name:WOODMORE, TAYLOR DENISE
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:DENISE
Last Name:WOODMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E MEMORIAL RD STE 700
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2287
Mailing Address - Country:US
Mailing Address - Phone:405-445-3485
Mailing Address - Fax:
Practice Address - Street 1:401 E MEMORIAL RD STE 700
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2287
Practice Address - Country:US
Practice Address - Phone:405-445-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-23-252632106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician