Provider Demographics
NPI:1487166229
Name:PATTON, TAYLOR MARIE (LAT, ATC, OTC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:PATTON
Suffix:
Gender:F
Credentials:LAT, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64146-1117
Mailing Address - Country:US
Mailing Address - Phone:573-356-7730
Mailing Address - Fax:
Practice Address - Street 1:2861 NE INDEPENDENCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2379
Practice Address - Country:US
Practice Address - Phone:816-525-2840
Practice Address - Fax:816-525-2841
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO20200314572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program