Provider Demographics
NPI:1053729889
Name:DOUGLAS, TAYLOR BROOKS (RBT)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:BROOKS
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:35 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3484
Mailing Address - Country:US
Mailing Address - Phone:386-569-3346
Mailing Address - Fax:
Practice Address - Street 1:515 PALM COAST PKWY SW
Practice Address - Street 2:SUITE 6/7
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4739
Practice Address - Country:US
Practice Address - Phone:386-951-3044
Practice Address - Fax:866-610-0580
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other